在 HPTN 046 临床试验中接受随访的非洲妇女在分娩后第一年的 HIV 疾病进展情况。
HIV disease progression in the first year after delivery among African women followed in the HPTN 046 clinical trial.
机构信息
*Maternal and Pediatric Infectious Disease Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD; †Fred Hutchinson Cancer Research Center, Seattle, WA; ‡Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA; §University of Zimbabwe College of Medicine, Harare, Zimbabwe; ‖Centre for the AIDS Programme of Research in South Africa (CAPRISA), Nelson R Mandela School of Medicine, University of KwaZulu Natal, Durban, South Africa; ¶Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda; #Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; **Harvard School of Public Health, Boston, MA; ††Family Health International, Research Triangle Park, Chapel Hill, NC; ‡‡Johns Hopkins Medical Institutes, Baltimore, MD; §§National Institute of Allergy and Infectious Diseases, NIH, Bethesda, MD; ‖‖Maternal Adolescent and Child Health, University of the Witwatersrand, Johannesburg, South Africa, and ¶¶Statistical Center for HIV/AIDS Research and Prevention (SCHARP), Seattle, WA.
出版信息
J Acquir Immune Defic Syndr. 2013 Nov 1;64(3):299-306. doi: 10.1097/QAI.0b013e3182a2123a.
BACKGROUND
Starting lifelong antiretroviral therapy (ART) in HIV-infected pregnant women may decrease HIV progression and transmission, but adherence after delivery may be difficult, especially for asymptomatic women. We evaluated disease progression among HIV-infected women not on ART with CD4⁺ lymphocyte counts above 200 cells per microliter at delivery.
METHODS
We analyzed risk of death, progression to AIDS (stage IV or CD4 < 200 cells per microliter), or to CD4⁺ count <350 1 year after delivery among postpartum women enrolled to a prevention of breastfeeding transmission trial using the Kaplan-Meier method. In the primary analysis, women were censored if ART was initiated.
RESULTS
Among 1285 women who were not WHO stage IV or less at 6 weeks postpartum, 49 (4.3%) progressed to stage IV/CD4 <200 cells per microliter or death by 1 year. Progression to CD4 <200 cells per microliter or death occurred among 16 (4.3%) of 441 women with CD4 count of 350-549 cells per microliter and 10 (1.6%) of 713 with CD4 counts >550 cells per microliter at delivery. CD4 <350 cells per microliter by 12 months postpartum occurred among 116 (37.0%) of 350 women with CD4 count 400-549 cells per microliter and 48 (7.4%) of 713 with CD4 count >550 cells per microliter at delivery.
CONCLUSIONS
Progression to AIDS or CD4 count <350 cells per microliter is uncommon through 1 year postpartum for women with CD4 counts over 550 cells per microliter at delivery, but occurred in over one third of those with CD4 counts under 550 cells per microliter. ART should be continued after delivery or breastfeeding among women with CD4 counts <550 cells per microliter if follow-up and antiretroviral adherence can be maintained.
背景
在 HIV 感染孕妇中启动终生抗逆转录病毒治疗（ART）可能会降低 HIV 的进展和传播，但产后的依从性可能很困难，尤其是对无症状的女性。我们评估了在分娩时 CD4 + 淋巴细胞计数超过 200 个/微升的未接受 ART 的 HIV 感染妇女的疾病进展情况。
方法
我们使用 Kaplan-Meier 方法分析了产后入组预防母乳喂养传播试验的女性在 1 年内死亡、进展为艾滋病（IV 期或 CD4 < 200 个/微升）或 CD4 + 计数 < 350 个/微升的风险。在主要分析中，如果开始接受 ART，则对女性进行删失。
结果
在 1285 名产后 6 周时未达到世界卫生组织（WHO）IV 期或更晚期的女性中，有 49 名（4.3%）在 1 年内进展为 IV 期/CD4 < 200 个/微升或死亡。在 CD4 计数为 350-549 个/微升的 441 名女性中，有 16 名（4.3%）和 CD4 计数 >550 个/微升的 713 名女性中有 10 名（1.6%）进展为 CD4 < 200 个/微升或死亡。在 CD4 计数为 400-549 个/微升的 350 名女性中，有 116 名（37.0%）和 CD4 计数 >550 个/微升的 713 名女性中有 48 名（7.4%）在产后 12 个月时 CD4 < 350 个/微升。
结论
对于在分娩时 CD4 计数超过 550 个/微升的女性，在产后 1 年内进展为艾滋病或 CD4 < 350 个/微升的情况并不常见，但在 CD4 计数低于 550 个/微升的女性中，超过三分之一的女性出现这种情况。如果能够进行随访和接受抗逆转录病毒治疗，应在产后继续为 CD4 < 550 个/微升的女性提供 ART 治疗或停止母乳喂养。
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