CESP INSERM U1018, Equipe VIH et IST Le Kremlin-Bicêtre, France.
J Acquir Immune Defic Syndr. 2011 Jun 1;57(2):126-35. doi: 10.1097/QAI.0b013e318219a3fd.
Few data are available on the possible long-term negative effects of a short exposure to antiretroviral therapy (ART) for prevention of mother-to-child transmission (PMTCT).
To determine whether ART for PMTCT, discontinued after delivery, affects the virological response to highly active antiretroviral therapy (HAART) administered during subsequent pregnancies.
All current pregnancies of HIV-1-infected women enrolled in the French Perinatal Cohort (ANRS CO-01 EPF) between 2005 and 2009 and not receiving ART at the time of conception were eligible. We studied the association between history of exposure to ART during a previous pregnancy and detectable viral load (VL) under multitherapy at current delivery (VL ≥ 50 copies/mL).
Among 1116 eligible women, 869 were ART naive and 247 had received PMTCT during a previous pregnancy. Previous ART was protease inhibitor (PI)-based HAART in 48%, non-PI-based HAART in 4%, nucleoside reverse transcriptase inhibitor bitherapy in 19% and zidovudine monotherapy in 29% of the women. At current pregnancy, women with or without prior exposure to ART had similar CD4 cell counts and VL before ART initiation. PI-based HAART was initiated in 90% of the women. VL was undetectable (<50 copies/mL) at delivery in 65% of previously ART-naive women, 72% of women previously exposed to HAART, 62% previously exposed to bitherapy, and 67% previously exposed to monotherapy for prophylaxis (P = 0.42). Detectable VL was not associated with previous exposure in multivariate analysis (adjusted OR for previous versus no previous exposure to ART: 0.92; 0.95% confidence interval: 0.59 to 1.44).
Efficacy of PI-based combinations is not decreased in women previously exposed to various regimens of antiretroviral PMTCT.
关于接受短时间抗逆转录病毒疗法（ART）预防母婴传播（PMTCT）后可能产生的长期负面影响，相关数据有限。
确定接受 PMTCT 的 HIV-1 感染孕妇在分娩后停止 ART 治疗，是否会影响随后妊娠时接受高效抗逆转录病毒治疗（HAART）的病毒学反应。
本研究纳入了 2005 年至 2009 年期间参加法国围产期队列（ANRS CO-01 EPF）且妊娠时未接受 ART 的所有 HIV-1 感染孕妇。研究分析了既往妊娠期间接受 ART 暴露史与当前分娩时多药治疗下可检测到的病毒载量（VL）（VL≥50 拷贝/ml）之间的关系。
在 1116 名符合条件的孕妇中，869 名孕妇从未接受过 ART 治疗，247 名孕妇在既往妊娠期间接受过 PMTCT。既往 ART 治疗中，48%的孕妇接受过基于蛋白酶抑制剂（PI）的 HAART，4%的孕妇接受过非 PI 类 HAART，19%的孕妇接受过核苷逆转录酶抑制剂联合治疗，29%的孕妇接受过齐多夫定单药治疗。在当前妊娠时，无论是否有 ART 暴露史，两组孕妇在开始 ART 治疗前的 CD4 细胞计数和 VL 均无显著差异。90%的孕妇开始接受 PI 类 HAART。在未经 ART 治疗的孕妇中，65%的孕妇在分娩时 VL 检测不到（<50 拷贝/ml），在有 HAART 暴露史的孕妇中为 72%，在有联合治疗暴露史的孕妇中为 62%，在有单药预防暴露史的孕妇中为 67%（P=0.42）。多变量分析显示，VL 可检测与既往 ART 暴露无关（既往与无 ART 暴露的调整比值比[OR]：0.92；95%置信区间：0.59 至 1.44）。
在先前接受过各种抗逆转录病毒 PMTCT 方案治疗的女性中，PI 类联合方案的疗效并未降低。
