Weinberg Adriana, Harwood Jeri E F, McFarland Elizabeth J, Pappas Jennifer, Davies Jill, Kinzie Kay, Barr Emily, Paul Suzanne, Salbenblatt Carol, Soda Elizabeth, Vazquez Anna, Peloquin Charles A, Levin Myron J
Department of Pediatrics, University of Colorado Denver School of Medicine, Aurora, CO 80045, USA.
Infect Dis Obstet Gynecol. 2009;2009:621780. doi: 10.1155/2009/621780. Epub 2010 Jan 10.
HIV-infected pregnant women with undetectable plasma HIV RNA concentrations at delivery pose a minimal risk of vertical transmission. We studied the kinetics and the determinants of the virologic response to antiretroviral therapy in 117 consecutive pregnancies. Patients who initiated therapy during pregnancy had a VL decrease of 2 and 2.5 log(10) after 4 and 24 weeks, respectively. Therapeutic drug monitoring (TDM) of the protease inhibitors administered in doses recommended for nonpregnant adults resulted in below-target concentrations in 29%, 35%, and 44% of 1st, 2nd, and 3rd trimester measurements, respectively, but low drug concentrations did not correlate with virologic failure. Demographic characteristics, antiretroviral experience prior to pregnancy, baseline VL, or use of specific antiretrovirals did not affect the virologic response. Adherence to >/=95% of prescribed doses and utilization of psychosocial services were associated with undetectable plasma HIV RNA at delivery. In conclusion, the virologic responses of pregnant and nonpregnant adults share similar characteristics.
分娩时血浆中HIV RNA浓度检测不到的HIV感染孕妇发生垂直传播的风险极小。我们研究了117例连续妊娠中抗逆转录病毒治疗病毒学反应的动力学及决定因素。孕期开始治疗的患者在4周和24周后病毒载量（VL）分别下降2和2.5个对数（10）。按照非妊娠成人推荐剂量给药的蛋白酶抑制剂的治疗药物监测（TDM）结果显示，在孕早期、孕中期和孕晚期测量中，分别有29%、35%和44%的测量值低于目标浓度，但低药物浓度与病毒学失败无关。人口统计学特征、妊娠前的抗逆转录病毒治疗经历、基线VL或特定抗逆转录病毒药物的使用均不影响病毒学反应。坚持服用≥95%的规定剂量以及利用社会心理服务与分娩时血浆HIV RNA检测不到有关。总之，妊娠和非妊娠成人的病毒学反应具有相似特征。
