Inserm, Centre for Research in Epidemiology and Population Health, U1018, Epidemiology of HIV and STI Team, Le Kremlin-Bicêtre, France.
AIDS. 2013 Jan 28;27(3):357-67. doi: 10.1097/QAD.0b013e32835ac8bc.
A part of women starting antiretroviral therapy during pregnancy fail to attain undetectable viral load by delivery. Here we studied whether pregnancy affects the early immunovirological response to combined antiretroviral therapy (cART), taking into account treatment duration and baseline characteristics.
Antiretroviral-naive women initiating cART since 2004 and followed in three French ANRS multicenter HIV cohorts (French Perinatal Cohort, PRIMO and COPANA).
The early virological response (at 1, 3 and 6 months) and immunological increase after cART initiation were compared between women starting cART during (n = 708) and outside (n = 110) pregnancy. Relative risks were estimated in multivariate models adjusted for treatment duration, baseline viral load and CD4, sociodemographic factors and chronic hepatitis B. CD4 increases were compared by using mixed models.
Only 63.8% of treated pregnant women attained a viral load less than 50 copies/ml by delivery. Similarly to nonpregnant women, nearly 90% of pregnant women reached a viral load less than 400 copies/ml at M3 [adjusted RR: 1.0 (95% confidence interval 0.7-1.4)], and nearly 100% at M6 following cART initiation [0.9 (0.4-1.9)]. viral load less than 50 copies/ml was attained by 61.5% of pregnant versus 67.9% of nonpregnant women at M3 (P = 0.26), and by 82.1 versus 87.0% at M6 (P = 0.48). CD4 recovery (both number and percentage) was similar in pregnant and nonpregnant women. Results were similar for the subset of women starting a boosted protease inhibitor-containing cART.
Pregnancy does not affect the virological response to cART below 400 copies/ml, or CD4 increase. The main reason for pregnant women not achieving viral load less than 50 copies/ml at delivery appears to be a short duration of treatment.
部分在孕期开始接受抗逆转录病毒治疗的女性未能在分娩时达到病毒载量不可检测的水平。在此，我们研究了孕期是否会影响到联合抗逆转录病毒治疗（cART）的早期免疫病毒学反应，同时考虑了治疗持续时间和基线特征。
2004 年以来，在法国三个 ANRS 多中心 HIV 队列（法国围产期队列、PRIMO 和 COPANA）中，接受 cART 治疗且未感染过 HIV 的女性。
比较了孕期开始（n=708）和孕期外开始（n=110）cART 的女性在 cART 启动后 1、3 和 6 个月时的早期病毒学应答（早期 virological response）和免疫应答。在多变量模型中，通过调整治疗持续时间、基线病毒载量和 CD4、社会人口因素和慢性乙型肝炎等因素，估计了相对风险。使用混合模型比较了 CD4 的增加。
只有 63.8%的接受治疗的孕妇在分娩时病毒载量小于 50 拷贝/ml。与非孕妇相似，近 90%的孕妇在 M3 时达到病毒载量小于 400 拷贝/ml（调整后的 RR：1.0（95%置信区间 0.7-1.4）），并且在 cART 启动后近 100%在 M6 时达到病毒载量小于 400 拷贝/ml[0.9（0.4-1.9）]。在 M3 时，61.5%的孕妇达到了病毒载量小于 50 拷贝/ml，而非孕妇为 67.9%（P=0.26），在 M6 时，82.1%的孕妇达到了病毒载量小于 50 拷贝/ml，而非孕妇为 87.0%（P=0.48）。在接受含蛋白酶抑制剂的强化 cART 的孕妇亚组中，CD4 恢复（无论是数量还是百分比）在孕妇和非孕妇中相似。
孕期不会影响到病毒载量低于 400 拷贝/ml 的 cART 反应或 CD4 增加。孕妇在分娩时未能达到病毒载量小于 50 拷贝/ml 的主要原因似乎是治疗持续时间较短。
