*Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA; †Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, MA; and ‡National Vaccine Program Office/Office of the Assistant Secretary for Health/Office of the Secretary/Department of Health and Human Services, Washington, DC.
J Acquir Immune Defic Syndr. 2013 Aug 15;63(5):593-601. doi: 10.1097/QAI.0b013e31829b0b9f.
Women who use antiretroviral therapy (ART) solely for the prevention of mother-to-child transmission of HIV discontinue postpartum. We hypothesized that women discontinuing ART by 6 weeks postpartum ("discontinuers") would have elevated postpartum inflammatory biomarker levels relative to women remaining on ART postpartum ("continuers").
Data from HIV-infected pregnant women enrolled in the International Maternal Pediatric Adolescent AIDS Clinical Trials Group P1025 with CD4 counts >350 cells per cubic millimeter before initiating ART or first pregnancy CD4 counts >400 cells per cubic millimeter after starting ART and with available stored plasma samples at >20 weeks of gestation, delivery, and 6 weeks postpartum were analyzed. Plasma samples were tested for highly sensitive C-reactive protein, D-dimer, and interleukin-6. We used longitudinal linear spline regression to model biomarkers over time.
Data from 128 women (65 continuers and 63 discontinuers) were analyzed. All biomarkers increased from late pregnancy to delivery, then decreased postpartum (slopes different from 0, P < 0.001). Continuers had a steeper decrease in log D-dimer between delivery and 6 weeks postpartum than discontinuers (P = 0.002).
In contrast to results from treatment interruption studies in adults, both ART continuers and ART discontinuers had significant decreases in the levels of D-dimer, highly sensitive C-reactive protein, or interleukin-6 postpartum. Continuation was associated with a more rapid decline in D-dimer levels compared with discontinuation.
仅使用抗逆转录病毒疗法（ART）预防艾滋病毒母婴传播的女性会在产后停止使用。我们假设，与产后继续使用 ART 的女性（“继续者”）相比，在产后 6 周内停止使用 ART 的女性（“中断者”）产后炎症生物标志物水平会升高。
分析了参与国际母婴儿科青少年艾滋病临床试验组 P1025 的 HIV 感染孕妇的数据，这些孕妇在开始使用 ART 前或首次妊娠 CD4 计数>350 个细胞/立方毫米，或开始 ART 后首次妊娠 CD4 计数>400 个细胞/立方毫米，并且在妊娠 20 周以上、分娩时和产后 6 周时可获得储存的血浆样本。检测血浆样本中高敏 C 反应蛋白、D-二聚体和白细胞介素-6 的水平。我们使用纵向线性样条回归来模拟随时间变化的生物标志物。
分析了 128 名女性（65 名继续者和 63 名中断者）的数据。所有生物标志物均从妊娠晚期到分娩时增加，然后在产后下降（斜率不为 0，P<0.001）。与中断者相比，继续者在分娩后 6 周内 D-二聚体的对数下降更为陡峭（P=0.002）。
与成人中断治疗研究的结果相反，ART 继续者和 ART 中断者在产后 D-二聚体、高敏 C 反应蛋白或白细胞介素-6 的水平均显著下降。与中断相比，继续与 D-二聚体水平的快速下降相关。
