Division of Infectious Diseases, University Children's Hospital, Basel, Switzerland.
HIV Med. 2011 Apr;12(4):228-35. doi: 10.1111/j.1468-1293.2010.00876.x. Epub 2010 Aug 18.
There is an ongoing debate as to whether combined antiretroviral treatment (cART) during pregnancy is an independent risk factor for prematurity in HIV-1-infected women.
The aim of the study was to examine (1) crude effects of different ART regimens on prematurity, (2) the association between duration of cART and duration of pregnancy, and (3) the role of possibly confounding risk factors for prematurity.
We analysed data from 1180 pregnancies prospectively collected by the Swiss Mother and Child HIV Cohort Study (MoCHiV) and the Swiss HIV Cohort Study (SHCS).
Odds ratios for prematurity in women receiving mono/dual therapy and cART were 1.8 [95% confidence interval (CI) 0.85-3.6] and 2.5 (95% CI 1.4-4.3) compared with women not receiving ART during pregnancy (P=0.004). In a subgroup of 365 pregnancies with comprehensive information on maternal clinical, demographic and lifestyle characteristics, there was no indication that maternal viral load, age, ethnicity or history of injecting drug use affected prematurity rates associated with the use of cART. Duration of cART before delivery was also not associated with duration of pregnancy.
Our study indicates that confounding by maternal risk factors or duration of cART exposure is not a likely explanation for the effects of ART on prematurity in HIV-1-infected women.
目前仍存在争议，即孕期联合抗逆转录病毒治疗（cART）是否是 HIV-1 感染妇女早产的独立危险因素。
本研究旨在检验：（1）不同 ART 方案对早产的直接影响；（2）cART 持续时间与妊娠持续时间之间的关联；（3）早产的可能混杂危险因素的作用。
我们分析了前瞻性收集的来自瑞士母婴 HIV 队列研究（MoCHiV）和瑞士 HIV 队列研究（SHCS）的 1180 例妊娠数据。
与孕期未接受 ART 的女性相比，接受单药/二联疗法和 cART 的女性早产的比值比分别为 1.8（95%置信区间[CI] 0.85-3.6）和 2.5（95% CI 1.4-4.3）（P=0.004）。在具有母体临床、人口统计学和生活方式特征综合信息的 365 例妊娠的亚组中，没有迹象表明母体病毒载量、年龄、种族或注射毒品使用史会影响与 cART 使用相关的早产率。分娩前 cART 的持续时间与妊娠持续时间也没有关联。
我们的研究表明，母体危险因素或 cART 暴露时间的混杂并不是 ART 对 HIV-1 感染妇女早产影响的可能解释。
