初治和经治HIV阳性女性的妊娠结局：来自ICONA基金会研究小组1997 - 2013年的数据。
Pregnancy outcomes among ART-naive and ART-experienced HIV-positive women: data from the ICONA foundation study group, years 1997-2013.
作者信息
d'Arminio Monforte Antonella, Galli Laura, Lo Caputo Sergio, Lichtner Miriam, Pinnetti Carmela, Bobbio Nicoletta, Francisci Daniela, Costantini Andrea, Cingolani Antonella, Castelli Francesco, Girardi Enrico, Castagna Antonella
机构信息
*Department of Health Sciences, Clinic of Infectious and Tropical Diseases, University of Milan, Milan, Italy; †Infectious Diseases, San Raffaele Hospital, Milan, Italy; ‡Infectious Diseases, Bagno a Ripoli Hospital, Florence, Italy; §Department of Health and Infectious Diseases, University La Sapienza, Polo Pontino, Rome, Italy; ‖Infectious Diseases, INMI "L. Spallanzani," I.R.C.C.S, Rome, Italy; ¶Infectious Diseases, Galliera Hospital, Genova, Italy; #Infectious Diseases, University of Perugia, Perugia, Italy; **Clinical Immunology, University of Ancona, Ancona, Italy; ††Infectious Diseases, University Sacro Cuore, Rome, Italy; ‡‡Division of Infectious and Tropical Diseases, Spedali Civili, University of Brescia, Brescia, Italy; and §§INMI "L. Spallanzani," I.R.C.C.S, Epidemiology, Rome, Italy.
出版信息
J Acquir Immune Defic Syndr. 2014 Nov 1;67(3):258-67. doi: 10.1097/QAI.0000000000000297.
BACKGROUND
We analyzed antiretroviral therapy (ART) regimens and pregnancy outcomes in naive and ART-experienced HIV-positive women from Italian Cohort Naive Antiretrovirals cohort and investigated frequency and predictors of detectable viral load (VL) at delivery.
METHODS
All pregnancies resulting in live births were included. Based on ART at the beginning of pregnancy, pregnancies were allocated either to the ART-naive or ART-experienced group. Analyses were stratified according to calendar periods. Multivariate logistic regression was used to describe predictors of detectable VL at delivery.
RESULTS
One hundred fifty-eight of 2862 women experienced 169 pregnancies (88 in naives and 81 in 70 ART-experienced women). ART regimens varied according to calendar periods; mono-dual combination regimens progressively decreased over time (P value for trend <0.0001). Protease inhibitor-including regimens were the most frequently used regimens at delivery (71.6% vs 63.0% in naives and in ART experienced, P = 0.2). VL was detectable in 35.6% of women at delivery; this was less likely with increasing calendar periods (adjusted odds ratio per 1-year longer: 0.8, 95% confidence interval: 0.7 to 0.9, P = 0.007) and more likely in women with HIV RNA >50 copies per milliliter at pregnancy ascertainment (adjusted odds ratio: 7.1, 95% confidence interval: 1.9 to 33.3, P = 0.006). Nevertheless, no cases of vertical transmission were diagnosed. Preterm birth rate of 17.3% (11.9% vs 22.6% naive and ART experienced, P = 0.1) was reported; this was not associated with ART duration or protease inhibitor-including regimens; 27.2% of infants had <2500 g birth weight.
CONCLUSIONS
Antiretroviral regimens prescribed during pregnancy changed over time according to guidelines. Although undetectable VL was not always achieved, no vertical transmission occurred; preterm delivery and low birth weight occurred in some cases and still remain key issues.
背景
我们分析了来自意大利初治抗逆转录病毒队列中初治和有抗逆转录病毒治疗经验的HIV阳性女性的抗逆转录病毒治疗（ART）方案及妊娠结局，并调查了分娩时可检测到病毒载量（VL）的频率和预测因素。
方法
纳入所有分娩活产儿的妊娠。根据妊娠开始时的ART情况，将妊娠分为初治组或有治疗经验组。分析按日历时间段进行分层。采用多变量逻辑回归来描述分娩时可检测到VL的预测因素。
结果
2862名女性中有158名经历了169次妊娠（初治组88次，70名有治疗经验的女性中有81次）。ART方案随日历时间段而变化；单药 - 双药联合方案随时间逐渐减少（趋势P值<0.0001）。含蛋白酶抑制剂的方案是分娩时最常用的方案（初治组和有治疗经验组分别为71.6%和63.0%，P = 0.2）。35.6%的女性在分娩时可检测到VL；随着日历时间段增加，检测到VL的可能性降低（每延长1年的调整比值比：0.8，95%置信区间：0.7至0.9，P = 0.007），而在妊娠确诊时HIV RNA>50拷贝/毫升的女性中检测到VL的可能性更高（调整比值比：7.1，95%置信区间：1.9至33.3，P = 0.006）。然而，未诊断出垂直传播病例。报告的早产率为17.3%（初治组和有治疗经验组分别为11.9%和22.6%，P = 0.1）；这与ART疗程或含蛋白酶抑制剂的方案无关；27.2%的婴儿出生体重<2500克。
结论
孕期开具的抗逆转录病毒方案随时间根据指南发生了变化。尽管并非总能实现病毒载量不可检测，但未发生垂直传播；某些情况下发生了早产和低出生体重，这些仍然是关键问题。
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