Department of Public Health, City University London, London, United Kingdom.
J Acquir Immune Defic Syndr. 2011 Aug 1;57(4):326-33. doi: 10.1097/QAI.0b013e31821d34d0.
Increasing numbers of women in resource-rich settings are prescribed zidovudine (ZDV)-sparing highly active antiretroviral therapy (HAART) in pregnancy. We compare ZDV-sparing with ZDV-containing HAART in relation to maternal viral load at delivery, mother-to-child transmission (MTCT) of HIV, and congenital abnormality.
This is an analysis of data from the National Study of HIV in Pregnancy and Childhood and the European Collaborative Study. Data on 7573 singleton births to diagnosed HIV-infected women between January 2000 and June 2009 were analyzed. Logistic regression models were fitted to estimate adjusted odds ratios (AORs).
Overall, 15.8% (1199 of 7573) of women received ZDV-sparing HAART, with increasing use between 2000 and 2009 (P < 0.001). Nearly a fifth (18.4%) of women receiving ZDV-sparing HAART in pregnancy had a detectable viral load at delivery compared with 28.6% of women on ZDV-containing HAART [AOR 0.90; 95% confidence interval (CI): 0.72 to 1.14, P = 0.4]. MTCT rates were 0.8% and 0.9% in the ZDV-sparing and ZDV-containing groups, respectively (AOR 1.81; 95% CI: 0.77 to 4.26, P = 0.2). The congenital abnormality rate was the same in both groups (2.7%, AOR 0.98; 95% CI: 0.66 to 1.45, P = 0.9), with no significant difference between the groups in a subanalysis of pregnancies with first trimester HAART exposure (AOR 0.79; 95% CI: 0.48 to 1.30, P = 0.4).
We found no difference in risk of detectable viral load at delivery, MTCT, or congenital abnormality when comparing ZDV-sparing with ZDV-containing HAART. With increasing use of ZDV-sparing HAART, continued monitoring of pregnancy outcomes and long-term consequences of in utero exposure to these drugs is required.
在资源丰富的环境中，越来越多的妇女在怀孕期间接受齐多夫定（ZDV）节省的高效抗逆转录病毒治疗（HAART）。我们比较了 ZDV 节省与 ZDV 包含的 HAART 在分娩时的母体病毒载量、母婴传播（MTCT）的 HIV 以及先天异常方面的关系。
这是对国家 HIV 妊娠和儿童研究和欧洲协作研究的数据进行的分析。对 2000 年 1 月至 2009 年 6 月期间诊断为 HIV 感染的 7573 名单胎分娩妇女的数据进行了分析。使用逻辑回归模型来估计调整后的优势比（AOR）。
总体而言，15.8%（7573 名中的 1199 名）的妇女接受了 ZDV 节省的 HAART，在 2000 年至 2009 年期间使用量不断增加（P<0.001）。近五分之一（18.4%）接受 ZDV 节省的 HAART 的孕妇在分娩时的病毒载量可检测到，而 ZDV 包含的 HAART 组为 28.6%（AOR 0.90；95%置信区间[CI]：0.72 至 1.14，P=0.4）。ZDV 节省和 ZDV 包含组的 MTCT 率分别为 0.8%和 0.9%（AOR 1.81；95%CI：0.77 至 4.26，P=0.2）。两组的先天异常率相同（2.7%，AOR 0.98；95%CI：0.66 至 1.45，P=0.9），在 HAART 暴露于早孕的妊娠亚分析中，两组之间没有显著差异（AOR 0.79；95%CI：0.48 至 1.30，P=0.4）。
在比较 ZDV 节省与 ZDV 包含的 HAART 时，我们没有发现分娩时可检测到的病毒载量、MTCT 或先天异常的风险差异。随着 ZDV 节省的 HAART 的使用增加，需要继续监测妊娠结局和这些药物在子宫内暴露的长期后果。
