Dignitas International, Zomba, Malawi.
PLoS One. 2012;7(9):e44396. doi: 10.1371/journal.pone.0044396. Epub 2012 Sep 4.
Maternal morbidity and mortality among HIV-infected women is a global concern. This study compared mortality and health outcomes of HIV-infected and HIV-uninfected mothers at 18-20 months postpartum within routine prevention of mother-to-child transmission of HIV (PMTCT) services in a rural district in Malawi.
A retrospective cohort study of mother-child dyads at 18-20 months postpartum in Zomba District. Data on socio-demographic characteristics, service uptake, maternal health outcomes and biometric parameters were collected.
173 HIV-infected and 214 HIV-uninfected mothers were included. HIV-specific cohort mortality at 18-20 months postpartum was 42.4 deaths/1000 person-years; no deaths occurred among HIV-uninfected women. Median time to death was 11 months post-partum (range 3-19). Women ranked their health on a comparative qualitative scale; HIV-infected women perceived their health to be poorer than did HIV-uninfected women (RR 2.4; 95% CI 1.6-3.7). Perceived maternal health status was well correlated with an objective measure of functional status (Karnofsky scale; p<0.001). HIV-infected women were more likely to report minor (RR 3.8; 95% CI 2.3-6.4) and major (RR 6.2; 95% CI 2.2-17.7) signs or symptoms of disease. In multivariable analysis, HIV-infected women remained twice as likely to report poorer health [adjusted OR (aOR) 2.3; 95% CI 1.4-3.6], as did women with low BMI (aOR 2.1; 95% CI 1.1-4.0) and scoring lowest on the welfare scale (aOR 2.0; 95% CI 1.1-3.8).
HIV-infected women show increased mortality and morbidity at 18-20 months postpartum. In our rural Malawian operational setting, where there is documented under-application of ART and poor adherence to PMTCT services, these results support attention to optimizing maternal participation in PMTCT programs.
艾滋病毒感染者产妇的发病率和死亡率是一个全球性问题。本研究比较了在马拉维农村地区常规预防母婴传播艾滋病毒（PMTCT）服务中，18-20 个月产后的艾滋病毒感染和未感染母亲的死亡率和健康结局。
在赞比西地区对 18-20 个月产后的母婴对进行回顾性队列研究。收集社会人口统计学特征、服务利用、产妇健康结局和生物计量参数的数据。
173 名艾滋病毒感染和 214 名艾滋病毒未感染的母亲被纳入研究。18-20 个月产后艾滋病毒特有的队列死亡率为 42.4 例/1000 人年；未感染艾滋病毒的妇女无死亡。中位产后死亡时间为 11 个月（范围 3-19）。妇女根据比较定性尺度对自身健康状况进行评分；艾滋病毒感染妇女认为自己的健康状况比未感染艾滋病毒的妇女差（RR 2.4；95%CI 1.6-3.7）。感知到的产妇健康状况与客观功能状态（卡诺夫斯基量表；p<0.001）密切相关。艾滋病毒感染妇女更有可能报告轻微（RR 3.8；95%CI 2.3-6.4）和严重（RR 6.2；95%CI 2.2-17.7）疾病迹象或症状。在多变量分析中，艾滋病毒感染妇女报告健康状况较差的可能性仍然是两倍[调整后的比值比（aOR）2.3；95%CI 1.4-3.6]，BMI 较低的妇女（aOR 2.1；95%CI 1.1-4.0）和福利量表评分最低的妇女（aOR 2.0；95%CI 1.1-3.8）也是如此。
艾滋病毒感染妇女在产后 18-20 个月时显示出更高的死亡率和发病率。在我们的马拉维农村操作环境中，记录到抗逆转录病毒治疗的应用不足和对 PMTCT 服务的依从性差，这些结果支持关注优化产妇对 PMTCT 方案的参与。
