Faculty of Spatial Sciences, Population Research Centre, University of Groningen, The Netherlands.
AIDS Patient Care STDS. 2013 Mar;27(3):163-70. doi: 10.1089/apc.2012.0401.
Previous research regarding the effect of highly active antiretroviral treatment (HAART) on pregnancy outcomes shows conflicting results and is predominantly situated in developed countries. Recently, HAART is rapidly being scaled up in developing countries for prevention of mother-to-child transmission (PMTCT). This study compared adverse pregnancy outcomes among HIV infected women (N=516) who received either HAART (N=192)--mostly without protease inhibitor--or antepartum azidothymidine (AZT) with intrapartum nevirapine (N=324) from January 2008 to March 2012 through a PMTCT program in western India. We analyzed the effect of HAART on preterm births, low birth weight, and all adverse pregnancy outcomes combined using univariate and multivariate logistic regression models. Women on HAART had 48% adverse pregnancy outcomes, 25% preterm births, and 34% low birth weight children compared to respectively 32%, 13%, and 22% among women on AZT. Women receiving HAART were more likely to have adverse pregnancy outcomes and preterm births compared to women receiving AZT. Preconception HAART was significantly related to low birth weight children. This study demonstrated increased risk of adverse pregnancy outcomes with protease inhibitor excluded HAART. Prospective studies assessing the impact of HAART on MTCT as measured in terms of HIV-free survival among children are needed.
先前关于高效抗逆转录病毒治疗（HAART）对妊娠结局影响的研究结果相互矛盾，且主要集中在发达国家。最近，发展中国家正在迅速扩大 HAART 的使用范围，以预防母婴传播（PMTCT）。本研究通过印度西部的一个 PMTCT 项目，比较了 2008 年 1 月至 2012 年 3 月期间接受 HAART（192 例，大多未使用蛋白酶抑制剂）或产前叠氮胸苷（AZT）联合分娩期奈韦拉平（324 例）的 HIV 感染孕妇（N=516）的不良妊娠结局。我们使用单变量和多变量逻辑回归模型分析了 HAART 对早产、低出生体重和所有不良妊娠结局的影响。与 AZT 组相比，接受 HAART 的孕妇不良妊娠结局、早产和低出生体重儿的发生率分别为 48%、25%和 34%，而接受 AZT 的孕妇分别为 32%、13%和 22%。与接受 AZT 的孕妇相比，接受 HAART 的孕妇更有可能出现不良妊娠结局和早产。孕前接受 HAART 与低出生体重儿显著相关。本研究表明，排除蛋白酶抑制剂的 HAART 会增加不良妊娠结局的风险。需要开展前瞻性研究，评估 HAART 对母婴传播的影响，以衡量儿童的 HIV 无存活情况。
