南非约翰内斯堡高效抗逆转录病毒治疗持续时间和方案对母婴传播艾滋病毒风险的影响。

Effects of highly active antiretroviral therapy duration and regimen on risk for mother-to-child transmission of HIV in Johannesburg, South Africa.

机构信息

David Geffen School of Medicine at UCLA, Division of Infectious Diseases and Center for Clinical AIDS Research and Education, Los Angeles, CA, USA.

出版信息

J Acquir Immune Defic Syndr. 2010 May 1;54(1):35-41. doi: 10.1097/QAI.0b013e3181cf9979.

DOI:10.1097/QAI.0b013e3181cf9979

PMID:20216425

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC2880466/

Abstract

BACKGROUND

Limited information exists about effects of different highly active antiretroviral therapy (HAART) regimens and duration of regimens on mother-to-child transmission (MTCT) of HIV among women in Africa who start treatment for advanced immunosuppression.

METHODS

Between January 2004 to August 2008, 1142 women were followed at antenatal antiretroviral clinics in Johannesburg. Predictors of MTCT (positive infant HIV DNA polymerase chain reaction at 4-6 weeks) were assessed with multivariate logistic regression.

RESULTS

Mean age was 30.2 years (SD = 5.0) and median baseline CD4 count was 161 cells per cubic millimeter (SD = 84.3). HAART duration at time of delivery was a mean 10.7 weeks (SD = 7.4) for the 85% of women who initiated treatment during pregnancy and 93.4 weeks (SD = 37.7) for those who became pregnant on HAART. Overall MTCT rate was 4.9% (43 of 874), with no differences detected between HAART regimens. MTCT rates were lower in women who became pregnant on HAART than those initiating HAART during pregnancy (0.7% versus 5.7%; P = 0.01). In the latter group, each additional week of treatment reduced odds of transmission by 8% (95% confidence interval: 0.87 to 0.99, P = 0.02).

CONCLUSIONS

Late initiation of HAART is associated with increased risk of MTCT. Strategies are needed to facilitate earlier identification of HIV-infected women.

摘要

背景

关于在开始治疗严重免疫抑制时接受治疗的非洲妇女中，不同高效抗逆转录病毒治疗（HAART）方案和方案持续时间对母婴传播（MTCT）的 HIV 影响，相关信息有限。

方法

2004 年 1 月至 2008 年 8 月期间，1142 名妇女在约翰内斯堡的产前抗逆转录病毒诊所接受了随访。采用多变量逻辑回归评估 MTCT（婴儿 HIV DNA 聚合酶链反应在 4-6 周时阳性）的预测因素。

结果

平均年龄为 30.2 岁（标准差=5.0），中位基线 CD4 计数为 161 个细胞/立方毫米（标准差=84.3）。在分娩时，85%开始在怀孕期间接受治疗的妇女的 HAART 持续时间为 10.7 周（标准差=7.4），而在 HAART 期间怀孕的妇女为 93.4 周（标准差=37.7）。总的 MTCT 率为 4.9%（874 例中的 43 例），不同 HAART 方案之间未发现差异。在 HAART 期间怀孕的妇女的 MTCT 率低于在怀孕期间开始 HAART 的妇女（0.7%比 5.7%；P=0.01）。在后一组中，每周增加一周治疗可使传播的几率降低 8%（95%置信区间：0.87 至 0.99，P=0.02）。