1. LAY TRUYEN HIV/AIDS TU ME SANG CON.PGS. TS.BS. Vii Thi Nhung
Ml)C TIEU BAI GIANG
1. Trinh bay Qlf(YC diin tdn cua Slf phat trdn dgi dich HIV/AIDS tren thi gi&i.
2. Trinh bay au(lc ca chi gay b¢nh ciia HIV.
3. Ki alf(lc cac yiu t6 anh hu&ng din ry !¢ lay nhiim HIV tic nu; sang con.
4. Neu alf(lc cclc nguyen tac szi' dimg thu6c ARV trong d!t phong lay nhiim HIV ti/- m(!
sang con.
LJCH SUNHIEM HIV
Thang 8 nam 1982 tr "AIDS" dugc dung tren bao vit tlp chi khoa hQc d~ n6i d€n b~nh suy
giam mi~n dich lien quan d€n nguoi dbng tinh"(AID) vit lfrn dfru tien vito thang 9 nam 1982,
CDC da dinh nghia AIDS v6i ynghTa "H{ji cftimg suy giiim miln dich mtic phiit' [I iJ. thang
12 nam 1982, CDC bao cao truong hqp dfru tien lay truy~n AIDS tr my sang con. l12
l Yao
thang 5/1983 Luc Montagnier vit c<)ng SI cua Vi~n Pasteur Phap tuyen b6 r~ng hQ da phan l~p
dugc m<)t loli Virus m6i ma h9 nghl r~ng d6 lit nguyen nhiin cua AIDS. M~u virus nay dugc
giri cho CDC. Viti thang sau, virus dugc d~t ten lit Lymphadenopathy-associated Virus gQi tfit
la LAV. thang 4/1985 tli Atlanta da di@n ra H<)i nghi Qu6c t€ v~ AIDS v&i SI tham di,r ctia
hO'll 2.000 nguoi. Sau h<)i nghi nay, WHO da t6 chuc h<)i thao qu6c t€ d~ xem AIDS Iii if<Ji
dich va bfit dfru hilnh d<)ng.
Thang 5/1986 H<)i nghi danh phap qu6c t~ th6ng nh~t gQi ten vims la HIV (Human
Immunodeficiency Vims). thang 3/1987, FDA c6ng nMn AZT Iii thubc kluing retrovims ifflu
tien dugc dung d~ chfra AIDS. Nhfrng hi~u bi~t v~ SI lay tmy~n b~nl1 thay d6i r~t nhi~u, d~c
bi~t la khi c6 baa cao dfru tien v~ sv lfiy bfnh t1I· mr sang con qua sli'a mr (thang 7/1987).
Nguai ta ciing nh~n th~y h<)i chilng suy giam mi~n dich con c6 th~ g~p 6 nhfrng nguoi b~nh
da bi tmy~n mau va cac ch~ ph~m cua mau c6 HIV hay 6 nguoi tiem chich ma ti'.1y dung
chung kim tiem v6i nguoi c6 HIV. Nam 1991, diii n<1 ilo tr6 thilnh bi~u tugng qu6c t~ v~
AIDS. Deo dai na do la th~ hien SI hii trg d6i v6i nhfrng nguoi s6ng v6i HIV/AIDS.
a.M<)t nua giiii Nobel Y hpc 2008 da dugc trao cho Francoise Barre-Sinoussi vii Luc
Montagnier cua Vi~n Pasteur Paris vi c6ng trinh phat hi~n HIV cua h9. Nguoi nhi€m HIV
trai qua nhi~u nam kh6ng c6 bi~u hi~n Jam sang nhung nguoi b~nh mang HIV su6t doi va la
173
2. SAN KHOA
ngu6n lay b~nh cho nguai khac. Thai gian di~n ti~n tir HIV sang AIDS dai hay ng~n la my
thu<)c himh vi nguy ca vii kha niing mi~n d[ch cua nguai b~nh. M~c du chua c6 thu6c chfra
kh6i b~nh nhung nha sv· hi~u qua cua thu6c ARV, ty I~ tir vong giam anhfrng nai cung dp
thu6c d§y du trong khi tinh tn,mg lay b~nh v~n ti~p t)c. Do d6, s6 nguai s6ng v6i AIDS ngay
cang tang rni. 0 Vi~t Nam, k~ tir khi tnrang hqp nhi~m HIV d§u tien duc;rc phat hi~n vao thing
12 nam 1990, s6 nguai duc;rc phat hi~n c6 HIV ti~p t)c tang cao. Ph§n 16n nguai nhi~m HIV
du9·c phat hi¢n la anh6m tu6i tir 20-39 (chi~m 82%), tre em du6i 15 tu6i chiem gfin 3%. r
19
l
D~C DIEM CAU T~O CUA HIV
Human immunodeficiency virus (HIV) thu<)c h9 retrovirus duc;rc x~p vao nh6m virus nhan !en
ch~m (lentivirus). Day la lo?i virus c6 v~t li¢u di truy€n la ARN se duc;rc chuy~n thimh hai
chu6i ADN nha men sao chep nguc;rc (reverse transcriptase).
HIV g6m hai lo?i HIV-I vii HIV-2. Loli HIV-I c6 kha niing truy€n b¢nh va d<)c tinh cao
hem HIV-2. Lo?i HIV-I duc;rc phat hi¢n tm6c tien va duc;rc d~t ten la LAV vii HTLV-III. Virut
nay ph6 bi~n tren toan du.trong khi t§n sufrt nhi~m HIV-2 it h011 va chu y~u xuit hi~n aTiiy
Phi. P4
l
Tren kinh hi€n vi di~n tU:, HIV co d?ng hinh d.u duang kinh 100-120nm. Ph§n Joi (nhiin)
g6m c6 chu6i ARN, cac men sao chep nguc;rc vit nhi€u lo?i protein duc;rc d~t ten theo tr9ng
luc;rng phiin tU: trong d6 c6 lo?i p24. Lap ngoai c6 gp41 lien k~t v6i gpl20 lab<) ph~n cua HIV
c6 kha niing g~n k~t v6i t~ bao dich f7l.~~~~~~~~~~~~~~~~.,--,
(Ngu6n: Tai /i~u t~p hu~n Ph6ng lay truy~n HIV tif mf? sang con
4
)
3. Lay truyfm HIV/AIDS t!P me sang con
ca CHE SINH B~NH CUA HIV
HIV g~n vao tht.t thS nhfrng te bilo thu()c h~ mi€n dich cua ca thS chu ySu la te bilo Lympho T
CD4+, dli thl,lc bilo, te biio c6 tua (dendritic cells) theo tien trlnh 15
:
• gp120 g~n vao miing t~ biio, gp4l trq giup qua trinh hoa miing te biio vii d~y ARN ctia
virus vao trong te bao (Bu&c !).Tuy nhien, SJ! ket gin gpl20 v&i CD4 viin chua du dS
gay nhi€m te biio, gpl20 con phai gin v&i cac chemokines tac d1.1ng nhu nhfrng d6ng
tht.t thStren bb m~t te bilo (CCRS, CXCR4) de hoa nh~p mimg te biio 118
l.
• , ARN cua Virus duqc men sao chep nguqc sao chep thanh sqi ADN b6 sung cua virus
(Bu&c 2). Qua trinh sao chep kh6ng hoiin Mo nen t}o d()t bien trong m6i chu kY sao
chep, vi the HIV tranh duqc phan rng cua h~ th6ng mi~n dich va tiep t~IC t6n t(li,
khang thu6c.
• Sqi ARN vii chu6i ADN b6 sung k~t hqp thiinh chu6i kep ADN di qua mimg nhan te
biio vii duqc g~n chen vao nhi€m s~c thS cua te bao chu v&i sv h6 trq ctta men
Integrase (Bu&c 3)
• Khi te bao chu phan chia thi ADN cua Virus ciing duqc sao chep sang t~ bao con.
ADN nay c6 th~ t6n tli lau trong t& bao chu dlng ngu yen nen kh6ng c6 bi€u hi~n lam
sang nhung viin c6 th€ lay b~nh cho nguai khac.
• Sl! san sinh ra virus m&i do te bao chit sinh ra nha men Protease (Bu&c 4).
• H~u qua cua nhi~m HIV la s6 luqng te bao T CD4+ giam thfip theo ba cache chinh:
I. Te bao nhi€m virus bi huy di~t lrl,lC tiep.
2. Gia tang l~p trinh chet te bao (apoptosis) cua te bao bi nhi~m virus.
3. Te bao T CD4+ nhi~m virus bi di~t b&i t€ biio lympho CDS.
Khi n6ng d9 TCD4+ giam du&i nguii'ng binh thuang thi kha nang mi~n djch te bito bi m~t,
ca the b~nh nhan se d~ bi nhi~m trung ca h()i.
Sl! lay nhi~m HIV c6 thS xay ra do truy~n mau, tiep xuc v&i cac loli dich thS cua nguai
nhi~m HIV nhu tinh djch, djch am dIO, djch tiet aduang v~t tru&c khi xufit tinh, sfra m~.
Trang cac dich nay, HIV t6n tli du&i d(lng nhfrng v~t thS t1,l do va vintt §n trong te bao
lympho bi nhi€m.
175
4. SAN KHOA
,.....
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"" • L~ Men
' /Jr sao chep
.. -1~ ~~ "''. ,, ~..P ": lntegrase ..;.....
Saooh!pANDt~ ,.-.I',.,..,.,,, ~ ..)ARN cua VtrUS r. w,., ..J'J J ...... iA .......
~.A~;j~DN cua virus XS!n vao"•.fli'.
,, ><'"§ genome cua t~ bao ..._~
(Ngu6n: EMBO reports
17
)
TINH HINH NHIEM HIV/AIDS 0 PHl} NU' VA THAI PHl}
Tren th€ gi&i, sv lay nhi€m HIV la do tre bi lay ill me; c6 HIV (khoang 11%), 10% thu9c
nh6m d6i tuqng tiem chich ma my, 5%-10% do quan h~ dbng tinh nam, 5%-10% xay ra t(li ca
s& y t€, s6 con l(li la do quan h~ tinh dlc nam-nfr (chi€m 2/3 nhiing tru&ng hqp nhi~m m&i).
Phl nfr nhi~m HIV/AIDS ngay cang tang, hQ c6 th€ lay ill chbng, ill b(ln tinh dbng th&i hQ
c6 th€ lay cho b(ln tinh khac va nhiit la hQ c6 th€ lay cho con cua hQ. E>6i v&i quan h~ tinh dlc
khac phai, t)r l~ lay nhi~m ill nam sang nfr nhi€u l~n l&n han tU nfr sang nam. N€u c6 viem
nhi~m sinh dlc nhiit la khi c6 v€t loet sinh dl,lc do cac b~nh lay truy€n qua du&ng tinh dlc
(giang mai, l~u, Chlamydia, Herpes simplex...) thi kha nang lay b~nh cang cao. Nguyen nhiin
c6 th~ do HIV c6 nhi€u trong tinh dich vii n~m lau trong am d(lo, khi giao hqp d€ c6 nhiing
ch5n thuang sinh dlc la ti€n d€ cho viem nhi~m. SI! viem loet sinh dlc lam gia tang SIJ ti~p
XLI C gifra HIV vii cac t~ bao viem trong du&ng sinh dJC nhu TCD4, cac d(li thvc bao. Cac lo(li
16 bito nay khi bi nhi~m HIV se lam tang lay nhi€m HIV. Qua nhi€u nghien ct'.ru, ngu&i ta xac
nh(in r~ng lay nhi~m HIVcao nhiit qua du&ng h~u mon - lfl!C trilng, k~ ti~p la du&ng am d(IO
v< sau nfra la du&ng mi~ng. Pl
5. Liiy truyen HIV/AIDS tU> me sang con
Ngoai duimg lay qua quan h~ tinh dl,lc, ph1 nil' c6 th&bi nhi~m HIV do truy€n mau da bi
nhi€m b~nh, do tiem chich ma ruy. M9t di€u dang quan tam la sr lay truy€n HIV ru my sang
con (LTMC) khi nguoi phl nil' mang thai.
Thu6c ARV da giup ngan sv lay truy€n HIV ru my sang con m9t each dang k&.. Ty l~ tfr
vong do AIDS giam hon 50% ciing nhu tinh trlng tre m6 coi giam vi cha my chung khong
ch€t vi AIDS. s6 truimg hqp nhi€m m6i o qn Saharan (Phi Chau) giam gfin 15%, 6 Dong A
giam gfin 25%, aNam vii Dong Nam Agiam gfin 10% (2008) [IOJ.
LAY TRUYEN HIV TUM)): SANG CON
Cac duong Hiy truy~n HIV tir m~ sang con
Lay truy€n t.r my sang con Iii nguyen nhan chinh gay nhi€m HIV atre em.V6c tinh m6i ngily
c6 1.600 tre so sinh nhi€m HIV. Sf lay truy€n nay c6 th~ xay ra 6 ba giai do;:tn cua thai ky
ri.3
•
5
1: lay truy€n qua tir cung thuimg g~p vilo 3 thang gifra thai kY chi€m khoang 30%-50%;
Jay truy€n cao nhfrt Iii trong giai do;:in chuy&n dI (60% - 65%); Jay truy€n sau khi sanh (trong
giai doln cha con bu 111:) Iii 10%-15%. Nhi€u nghien ci'.ru dugc ti€n hilnh aHoa Ky, Chau
Phi, Thai Lan...cho thfry cac thu6c ARV lam giam n6ng d9 virus c6 tac dmg d& phong nglra
St lay trny€n nay [GI. Tru6c khi dua ARV vi10 chuong trinh di€u trj dr phong, nguy ca lay
nhi€m HIV t.r ITT: sang con t.r 15%-25% acac nu6c phat tri€n, c6 th~ cao hon anhfrng nu6c
dang pMt tri&n (25%-35%). N€u cho thu6c df phong vii m6 !fry thai c6 th& lam giam ty l~ lay
trny€n HIV con I%. [9
1Phan tich g9p cua 15 nghien cuu tren 8.355 truimg hgp thai phl nhi~m
HIV aB~c My vii Chau Au r16
l khi so sanh gifra m6 !fry thai (MLT) chu d9ng vii cac each sanh
khac thi t)r I~ Jay nhi~m cho con la 8,4% d6i v6i MLT va 16,7% v6i cac each sanh khac. N€u
thai phl dugc u6ng ARV ngay khi dang mang thai, trong chuy~n dI va sau sanh c6 MLT chu
d9ng thi t)r I~ lay cho con Iii 2% vii la 7,3% khi sanh nga am dlo. Truong hQ·p mt< hoiln toan
khong u6ng ARV thi t)r I~ Jay truy€n !fin lugt Iii 10,4% vii 19%.
Theo quan diem hi~n nay, aHoa Ky MLT chu d9ng Jue 38 tufin c6 lgi cha thai ph1 c6
> 1.000 ban sao virus /mL, thai phl khong bi€t ro n6ng d9 virus, vo 6i non khong c6 diiu
chuy~n dI. MLT khong c6 k€t qua t6t hon sanh thuimg n€u n6ng d9 vims du6i 1.000 ban
sao/mL. d Anh Qudc, m6 !fry thai tru6c khi chuy&n dI dugc khuy€n cao cho cac truo11g hgp
thai phl chi u6ng ZDV, thai phl c6 n6ng d9 virus (VL) > 400 ban sao/mL vao Jue thai 36
tufin, dn can nh~c khi thai phy c6 VL t.r 50-399 ban sao/mL, 1116 Jiiy thai tru6c k.hi chuy~n d?
thfc hien t.r 38-39 tufin. Thai phl c6 VL<50 ban sao/mL (luc thai 36 tufin) vii khong c6 ch6ng
chi djnh thi de sanh nga am dIO
Ngoai ra, bil m: c6 HIV con c6 th& phong nglra dugc Sf Jay b~nh cha con sau sanh biing
each khong cho con bum: vii cho tre u6ng thu6c df phong. rs.iii
177
6. SAN KHOA
Cac y~u ta anh hU'O'ng il~n ry I~ lay nhi~m HIV tir m~ sang con
Trang khi mang thai
• HIV co th~ duqc truybn tn,rc tiep ru m<; sang thai qua banh nhau m~c du banh nhau c6
m9t mimg ngan each v&i ru cung cua nguai m<; d~ baa v~ thai nhi, baa v~ cho 60% -
70% tre khong nhi€m HIV
• HIV c6 th~ qua thai do nhi€m khufin banh nhau, viem mang bi.
• HIV qua thai mu9n han, vao nira sau thai kY do b~ day cua mang nhau nhau mong di.
N6ng d9 virus/mau cang cao thi tY l~ lay nhi~m m<;-con cang cao. Thai di~m n6ng d9
HIV cao la Jue m&i chuy~n viio huySt thanh vii giai do11n cubi ctia AIDS.
Trang chuyin d(l, khi sinh ile
Cac yeu tb liim tang kha nang LTMC:
• Sb luqng virus c6 trong am d110 tang liim gia tang nguy ca nhi€m HIV khi thai di qua
amd110.
• Thai qua duc'rng am d110 c6 th~ nubt dich am d110 c6 nhibu HIV viio duc'rng tieu h6a, da
Vii niem ffiIC Cua tre tiep XUC VCTi mau Vii djch am dIO Cua m<; khi de duang du&i.
• Can co tir cung, si,r x6a ma c6 tir cung gay chiiy mau.
• Ph§n m~m cua nguai m<; bi d~p nat, cac can thi~p nhu dt t§ng sinh mon gay chiiy mau.
• Forceps ho~c giac hut c6 th~ gay sang ch§n!xay xu&c cho thai.
• ue kh6, chuy~n d11 keo diii.
• Thai gian ru khi va bi den khi sinh dai (d~c bi~t la sau 4 gia vii cir m&i gia sau khi va
bi nguy ca lay truy~n HIV ur m<; sang con tang them 2%) [91.
• Si,r suy giam mi~n dich n~ng duqc danh gia b~ng sb luqng CD4 thiip, tY l~ % CD~ th§p,
ty l~ CD4/CD8 cao. Theo European Collaborative Study (ESC) neu CD4 du&i 700/mm3
thi ty l~ liiy nhi€m cao. N6ng d9 khang th~ trung hoa cao thi tY I~ liiy nhi€m m<;-con
thfrp.
Lfiy truyin HIV tir m(! sang con trong thiri kjJ m(! cho con bu
• HIV c6 trong sfra m<; nen khi bu HIV c6 th~ xam nh~p qua niem m11c mi~ng, luai, !qi
cua dira tre gay liiy nhi~m cho tre, nh§t la trong tmc'rng hqp tre c6 cac viem nhi€m
trong mi~ng.
• Tmc'rng hqp Vll m<; c6 viem nhi€m, c6 vet nm, hay khi tre mQC rang c~n gay chiiy mau
thi HIV con c6 th~ theo mau vao mi~ng tre, xam nh~p qua niem m11c trong mi~ng vii
gay nhi~m cho tre.
• HIV ru mau m<; thfrm thiu vao cac nang sfra va c6 trong sfra m<;. TY l~ HIV duqc tim
thfry trong sfra cao trong thai kY d§u sau de, sau d6 giam d§n.
7. Lay truyen HIV/AIDS til' me sang con
• Niem nwc ru9t tre su sinh clma tnrcmg thitnh nen phiin (mg v6i siJ:a thay th~ lam t6n
thuang vi th~ 6 niem 111IC mi¢ng, HIV tir sii:a 111: d~ xfun nh~p. Vl th~ nguy co lay
truy~n HIV qua ducrng sii:a 111! angucri cho bt1k€t hgp v6i thtrc an thay th~ cao lwn
nuoi con b~ng sira 111i, (NCBSM) 110itn toan.
Dl/ PHONG LAY NHJEM HIV Tif M~ SANG CON
TY 1¢ lay truy~n HIV tl! mi, sang con thay d6i tir nghien ctru nay sang nghien cfru khac. 6 cac
nu6c phat tri€n, nguoi ta da ti~n hitnh nhi~u nghien cfru nh~m lam giii111 lay nhi~m mi,-con.
Nguyen t~c sfr d1,mg thufic ARV
• Nhung phv nu c6 thai chua duoc di~u td ARV d.n ouoc ctv· phong LTMC b~ng phac
d6 phu hgp v6i thcri di~m kham thai va thoi oi~m xac dinh nhi~111 HIV. Ph1 nit 111ang
thai da ougc di~u trj ARV thl khong cfin ap dvng phac 06 dr phong LTMC.
Theo khuy€n cao cua WHO tir thang 11/2009 r20
L dr phong ARV din duoc bfit o~u
SOI11 - ngay tfr tufin thtr 14 Clla thai ky - ho?c cang SOl11 citng t6t khi ba 111: d~n kham O
giai do(ln mu9n, luc chuy~n d? sanh, keo dai cho o€n m9t tufin sau khi ngirng cho b1.
Dv· phong ARV bao g6m:
o AZT hang ngay tnr6c khi sanh.
o NVP li~u dun l1c b~t dflu clrny~n d?
o AZT+3TC trong l1c chuy~n d? va khi sanh.
o AZT+3TC trong 7 ngity sau khi sanh.
K.hi nao di~u trj ARV cho thai pht? Theo khuy~n cao ctia WHO ttr thang 11/2009 l20
L
B~t dftu di~u tri ARV cho t~t ca plw nu mang thai (PNMT) nhi~111 HlV khi
CD4::; 350 t€ bito/111m3
khOng phv thu9c vi10 giai 00(111 lam sang cita WHO vii
cho t~t ca PNMT nhi~111 HIV agiai oo(ln lam sang 3 ho~c 4 theo WHO, khong
phv thu9c CD4.
PNMT nhi~111 HIV c6 chi dinh oi~u tri ARV d.n b~t dftu di~u tri khong ph1
thu9c tu6i thai, oi~u tri su6t qua trlnh mang thai, khi sanh vii sau khi sanh.
Phac 06 oi~u tri b~c l m1 tien phiii bao g6m AZT + 3TC lam t11,1 c9t:
AZT+3TC+NVP ho?c AZT+3TC+ EFV.
Cac phac dfl thay th€ ougc khuy~n cao: TDF+3TC (ho?c FTC) +NVP vii
TDF+3TC (ho?c FTC)+EFV
Dlf phong cho tre SO' sinh
T~t ca tre sinh ra tir mi, c6 HIV d~u phai dr phong b~ng thu6c ARV sau sanh.
Tre bu mi,: si'.r dvng NVP hang ngity !lr khi sanh cho d~n khi dugc 6 tu~n tu6i.
Tre khong bu mi,: sfr dvng AZT ho?c NVP tfr khi sanh cho d~n khi ouoc 6 tu~n tu6i.
179
8. SAN KHOA
KETLU~N
HIV co nhi~u niim khong co bi~u hi~n lilm sang nhtrng ngtrai b~nh mang HIV su6t dai va la
ngu6n lay b~nh cho nguai khac. Thai gian di~n ti€n tir HIV sang AIDS dai hay ng~n la tuy
thu(c hanh vi nguy ca va kha nang mi~n dich cirn nguai b~nh. M~c du chtra co thu6c chfra
kh6i b~nh nhung nha hi~u qua ci1a thu6c ARV, iy l~ tir vong giam anhfrng nai cung dp
thu6c d~y dt1 nhung tinh trjng liiy b~nh vfin ti€p ti,1c. Khi n6ng d( TCD4+ giam du&i nguang
binh tlmang thi kha niing mi~n dich 1€ bao bi mfit, ca th~ b~nh nhiin se d~ bi nhi~m trUng ca
h(i. D6i v&i phI nfr mang thai neu duqc phat hi~n nhi~m HIV s&m trong thai tj, duqc u6ng
ARV dr phong s&m thi tY l~ LTMC se giam con 2%-6%.
TAI LIJ):U THAM KHAO
Titi li~u Ti~ng Vi~t
l. Nguy€n Hfru Chi (2000) "Di;ic tliim dich ti h9c va 16111 sang ciia nhilm HIV/AIDS a
ph1;1 nii' ", Nhilm HIV/AIDS aph?t nir, trang 22-23.
2. Nguy~n Hlru Chi (2000) "Loy truyJn HIV tfr 111? sang con", Nhil111 HIV/AIDS aphi1
nfr, trang 95- l05.
3. Truong T Xuan Lien, Vu Thi Nhung (2007). "Danh gia ry 1¢ khang thu6c ARV trong
can thil}p tliJu tri dz/ phong lay truyJn HIV ti'r 111? sang con t9i TP HCM", Y hQc Tp
Hf> Chi Minh T~p 14 s6 3, 2010,Tr 137-142.
4. B( y te - Df an quy loan du (2006) Diln bidn wnhien va nguy C(J lay truyJn HIV.
Tai li~u t~p hufin phong lay truy~n HIV tir mt; sang con, Nhit xufit ban Y hQc 2006. Tr
16.
5. B( Y te -Dr an quy toan du (2006)"Lay truyJn HIV ti'r m? sang con: thai tliim, cac
ydu t6 nguy ca. Tai li~u t~p hufrn phong lily truy~n HIV tir mt; sang con", Nha xufit ban
Y hQc 2006. Tr 21-25
6. B( Y t€ - Df an quy toan du (2006) Si'r di111g thuJc khang Retrovirus. Tai li~u t~p
hufin phong liiy truy~n HIV tir mt; sang con, Nha xufit ban Y hQc 2006. Tr 51-52.
Tili li~u ti~ng Anh
7. Bureau of Hygiene & Tropical Diseases (I 986) 'AIDS newsletter' Issue Volume 2
Issue I January 15.
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