Laboratoire Epidémiologie, Centre Pasteur du Cameroun, Yaoundé, Cameroon.
PLoS One. 2010 Apr 29;5(4):e10411. doi: 10.1371/journal.pone.0010411.
Multidrug antiretroviral (ARV) regimens including HAART and short-course dual antiretroviral (sc-dARV) regimens were introduced in 2004 to improve Prevention of Mother-to-Child Transmission (PMTCT) in Cameroon. We assessed the effectiveness of these regimens from 6-10 weeks and 12 months of age, respectively.
METHODOLOGY/FINDINGS: We conducted a retrospective cohort study covering the period from October 2004 to March 2008 in a reference hospital in Cameroon. HIV-positive pregnant women with CD4 < or = 350 cells/mm(3) received first-line HAART [regimen 1] while the others received ARV prophylaxis including sc-dARV or single dose nevirapine (sd-NVP). Sc-dARV included at least two drugs according to different gestational ages: zidovudine (ZDV) from 28-32 weeks plus sd-NVP [regimen 2], ZDV and lamuvidine (3TC) from 33-36 weeks plus sd-NVP [regimen 3]. When gestational age was > or = 37 weeks, women received sd-NVP during labour [regimen 4]. Infants received sd-NVP plus ZDV and 3TC for 7 days or 30 days. Early diagnosis (6-10 weeks) was done, using b-DNA and subsequently RT-PCR. We determined early MTCT rate and associated risk factors using logistic regression. The 12-month HIV-free survival was assessed using Cox regression. Among 418 mothers, 335 (80%) received multidrug ARV regimens (1, 2, and 3) and MTCT rate with multidrug regimens was 6.6% [95%CI: 4.3-9.6] at 6 weeks, without any significant difference between regimens. Duration of mother's ARV regimen < 4 weeks [OR = 4.7, 95%CI: 1.3-17.6], mother's CD4 < 350 cells/mm(3) [OR = 6.4, 95%CI: 1.8-22.5] and low birth weight [OR = 4.0, 95%CI: 1.4-11.3] were associated with early MTCT. By 12 months, mixed feeding [HR = 8.7, 95%CI: 3.6-20.6], prematurity [HR = 2.3, 95%CI: 1.2-4.3] and low birth weight were associated with children's risk of progressing to infection or death.
Multidrug ARV regimens for PMTCT are feasible and effective in routine reference hospital. Early initiation of ARV during pregnancy and proper obstetrical care are essential to improve PMTCT.
包括高效抗逆转录病毒治疗（HAART）和短程双抗逆转录病毒（sc-dARV）方案在内的多种抗逆转录病毒药物方案于 2004 年引入，以改善喀麦隆的母婴传播预防（PMTCT）。我们分别评估了这些方案在 6-10 周和 12 个月时的效果。
方法/发现：我们在喀麦隆的一家参考医院进行了一项回顾性队列研究，涵盖了 2004 年 10 月至 2008 年 3 月的期间。CD4<350 个细胞/mm(3)的 HIV 阳性孕妇接受一线 HAART[方案 1]，而其他孕妇接受包括 sc-dARV 或单剂量奈韦拉平（sd-NVP）在内的抗逆转录病毒预防。sc-dARV 根据不同的胎龄包括至少两种药物：28-32 周时使用齐多夫定（ZDV）加 sd-NVP[方案 2]，33-36 周时使用 ZDV 和拉米夫定（3TC）加 sd-NVP[方案 3]。当胎龄≥37 周时，孕妇在分娩时接受 sd-NVP[方案 4]。婴儿接受 sd-NVP 加 ZDV 和 3TC 治疗 7 天或 30 天。使用 b-DNA 随后是 RT-PCR 进行早期诊断（6-10 周）。我们使用逻辑回归确定了早期母婴传播率和相关的危险因素。使用 Cox 回归评估了 12 个月的 HIV 无生存情况。在 418 位母亲中，有 335 位（80%）接受了多药 ARV 方案（1、2 和 3），多药方案在 6 周时的母婴传播率为 6.6%[95%CI：4.3-9.6]，方案之间没有显著差异。母亲的 ARV 方案持续时间<4 周[OR=4.7，95%CI：1.3-17.6]、母亲的 CD4<350 个细胞/mm(3)[OR=6.4，95%CI：1.8-22.5]和低出生体重[OR=4.0，95%CI：1.4-11.3]与早期母婴传播有关。在 12 个月时，混合喂养[HR=8.7，95%CI：3.6-20.6]、早产[HR=2.3，95%CI：1.2-4.3]和低出生体重与儿童感染或死亡的风险相关。
PMTCT 中使用多药 ARV 方案是可行且有效的，在常规参考医院中也是如此。在怀孕期间尽早开始 ARV 治疗和适当的产科护理对于改善 PMTCT 至关重要。
