Patel Deven, Cortina-Borja Mario, Thorne Claire, Newell Marie-Louise
Clin Infect Dis. 2007 Jun 15;44(12):1647-56. doi: 10.1086/518284. Epub 2007 May 2.
There have been no clinical trials in resource-rich regions that have addressed the question of which highly active antiretroviral therapy (HAART) regimens are more effective for optimal viral response in antiretroviral-naive, human immunodeficiency virus (HIV)-infected pregnant women.
Data on 240 HIV-1-infected women starting HAART during pregnancy who were enrolled in the prospective European Collaborative Study from 1997 through 2004 were analyzed. An interval-censored survival model was used to assess whether factors, including type of HAART regimen, race, region of birth, and baseline immunological and virological status, were associated with the duration of time necessary to suppress viral load below undetectable levels before delivery of a newborn.
Protease inhibitor-based HAART was initiated in 156 women (65%), 125 (80%) of whom received nelfinavir, and a nevirapine-based regimen was initiated in the remaining 84 women (35%). Undetectable viral loads were achieved by 73% of the women by the time of delivery. Relative hazards of time to achieving viral suppression were 1.54 (95% confidence interval, 1.05-2.26) for nevirapine-based HAART versus PI-based regimens and 1.90 (95% confidence interval, 1.16-3.12) for western African versus non-African women. The median duration of time from HAART initiation to achievement of an undetectable viral load was estimated to be 1.4 times greater in women receiving PI-based HAART, compared with women receiving nevirapine-based HAART. Baseline HIV RNA load was also a significant predictor of the rapidity of achieving viral suppression by delivery, but baseline immune status was not.
In this study, nevirapine-based HAART (compared with PI [mainly nelfinavir]-based HAART), western African origin, and lower baseline viral load were associated with shorter time to achieving viral suppression.
在资源丰富地区，尚无临床试验探讨哪种高效抗逆转录病毒疗法（HAART）方案对于初治的感染人类免疫缺陷病毒（HIV）的孕妇实现最佳病毒反应更为有效。
分析了1997年至2004年纳入前瞻性欧洲协作研究的240名在孕期开始接受HAART治疗的HIV-1感染女性的数据。采用区间删失生存模型评估包括HAART方案类型、种族、出生地区以及基线免疫和病毒学状态等因素是否与在新生儿分娩前将病毒载量抑制至不可检测水平所需的时间有关。
156名女性（65%）开始接受基于蛋白酶抑制剂的HAART治疗，其中125名（80%）接受奈非那韦治疗，其余84名女性（35%）开始接受基于奈韦拉平的方案治疗。73%的女性在分娩时实现了不可检测的病毒载量。与基于蛋白酶抑制剂的方案相比，基于奈韦拉平的HAART实现病毒抑制的时间相对风险为1.54（95%置信区间，1.05 - 2.26），西非女性与非非洲女性相比为1.90（95%置信区间，1.16 - 3.12）。与接受基于奈韦拉平的HAART的女性相比，接受基于蛋白酶抑制剂的HAART的女性从开始HAART治疗到实现不可检测病毒载量的中位时间估计长1.4倍。基线HIV RNA载量也是分娩时实现病毒抑制速度的重要预测因素，但基线免疫状态不是。
在本研究中，基于奈韦拉平的HAART（与基于蛋白酶抑制剂[主要是奈非那韦]的HAART相比）、西非血统以及较低的基线病毒载量与实现病毒抑制的时间较短有关。
