Townsend Claire L, Tookey Pat A, Cortina-Borja Mario, Peckham Catherine S
Centre for Paediatric Epidemiology and Biostatistics, Institute of Child Health, University College London, London, United Kingdom.
J Acquir Immune Defic Syndr. 2006 May;42(1):91-4. doi: 10.1097/01.qai.0000196667.24239.c2.
Antiretroviral therapy (ART) in pregnancy substantially reduces the risk of mother-to-child transmission of HIV, but concerns exist about the potential for teratogenic effects. This analysis was undertaken to explore the relation between ART in pregnancy and birth defects in infants born to HIV-infected women in the United Kingdom and Ireland between 1990 and 2003. Comprehensive obstetric and pediatric HIV surveillance is carried out through the National Study of HIV in Pregnancy and Childhood. Congenital abnormalities were reported in 101 of 3172 infants (100 of 3120 pregnancies). There was no statistically significant association between the prevalence of congenital abnormalities and exposure to ART overall: 3.4% (90 of 2657 pregnancies) in exposed pregnancies and 2.2% (10 of 463 pregnancies) in nonexposed pregnancies (P = 0.166); prevalence was similar whether or not exposure occurred in the first trimester: 3.7% (20 of 541 pregnancies) after early exposure and 3.1% (80 of 2579 pregnancies) without early exposure (P = 0.476). There was also no significant association with type of ART in early pregnancy (ie, highly active antiretroviral therapy [HAART] vs. mono- or dual therapy, HAART with protease inhibitor and/or nonnucleoside reverse transcriptase inhibitor). The lack of association was maintained after adjustment for potential confounding factors. These findings are reassuring, but continued monitoring is essential in view of the increasing number of women on therapy at conception and the likely continuing diversity of drug regimens.
孕期抗逆转录病毒疗法（ART）可大幅降低HIV母婴传播风险，但人们担心其可能产生致畸作用。本分析旨在探讨1990年至2003年间，英国和爱尔兰HIV感染女性孕期接受ART与所生婴儿出生缺陷之间的关系。通过全国孕期和儿童HIV研究对产科和儿科进行全面的HIV监测。在3172例婴儿中有101例（3120次妊娠中有100例）报告有先天性异常。先天性异常患病率与总体ART暴露之间无统计学显著关联：暴露妊娠中为3.4%（2657次妊娠中有90例），未暴露妊娠中为2.2%（463次妊娠中有10例）（P = 0.166）；无论是否在孕早期暴露，患病率相似：早期暴露后为3.7%（541次妊娠中有20例），未早期暴露为3.1%（2579次妊娠中有80例）（P = 0.476）。孕早期ART类型（即高效抗逆转录病毒疗法[HAART]与单药或双药疗法、含蛋白酶抑制剂和/或非核苷类逆转录酶抑制剂的HAART）之间也无显著关联。在对潜在混杂因素进行调整后，这种缺乏关联的情况依然存在。这些发现令人安心，但鉴于受孕时接受治疗的女性人数不断增加且药物治疗方案可能持续多样化，持续监测至关重要。
