Patel Deven, Thorne Claire, Newell Marie-Louise, Cortina-Borja Mario
Int J Infect Dis. 2009 Mar;13(2):266-73. doi: 10.1016/j.ijid.2008.07.004. Epub 2008 Oct 16.
To assess pregnancy levels and patterns of HIV RNA in the absence of antiretroviral therapy, while appropriately adjusting for potential confounders, including maternal immune status and race.
Data on > or = 1 antenatal HIV RNA measurements were available for 333 untreated HIV-infected pregnant women enrolled in the European Collaborative Study. CD4 counts and HIV RNA measurements were routinely collected from 1992 and 1998, respectively. Linear mixed effects models based on 246 women for whom complete data were available examined changes in HIV RNA levels over pregnancy, with a nested random effects term accounting for measurement variability within women and period of sample collection.
The change in HIV RNA over pregnancy varied significantly by race (p=0.005): from the second trimester until delivery, HIV RNA decreased significantly by an estimated 0.019 log(10) copies/ml/week in white women (95% CI -0.03, -0.007); in black women the estimated 0.016 log(10) copies/ml/week increase (95% CI -0.005, 0.037) was not statistically significant. At delivery, HIV RNA levels in black women were 0.45 log(10) copies/ml higher (95% CI 0.08, 0.83) than in white women.
Our findings suggest that HIV RNA dynamics over pregnancy differ by race, although other interpretations cannot be excluded, due to potential for unmeasured confounding.
在不进行抗逆转录病毒治疗的情况下，评估妊娠期间HIV RNA水平及变化模式，同时适当调整包括孕产妇免疫状态和种族在内的潜在混杂因素。
欧洲协作研究纳入的333名未接受治疗的HIV感染孕妇有≥1次产前HIV RNA测量数据。CD4细胞计数和HIV RNA测量分别于1992年和1998年开始常规收集。基于246名有完整数据的女性，采用线性混合效应模型研究妊娠期间HIV RNA水平的变化，采用嵌套随机效应项来解释女性个体内测量变异性及样本采集时间。
妊娠期间HIV RNA的变化因种族不同而有显著差异（p = 0.005）：从孕中期到分娩，白人女性的HIV RNA显著下降，估计每周下降0.019 log(10)拷贝/ml（95%可信区间 -0.03，-0.007）；黑人女性估计每周增加0.016 log(10)拷贝/ml（95%可信区间 -0.005，0.037），但无统计学意义。分娩时，黑人女性的HIV RNA水平比白人女性高0.45 log(10)拷贝/ml（95%可信区间0.08，0.83）。
我们的研究结果表明，妊娠期间HIV RNA动态变化因种族而异，尽管由于存在未测量的混杂因素，不能排除其他解释。
