与高效抗逆转录病毒治疗初治的 HIV 感染妇女在分娩时病毒未能抑制相关的因素：一项队列研究。
Factors associated with lack of viral suppression at delivery among highly active antiretroviral therapy-naive women with HIV: a cohort study.
出版信息
Ann Intern Med. 2015 Jan 20;162(2):90-9. doi: 10.7326/M13-2005.
BACKGROUND
A high delivery maternal plasma HIV-1 RNA level (viral load [VL]) is a risk factor for mother-to-child transmission and poor maternal health.
OBJECTIVE
To identify factors associated with detectable VL at delivery despite initiation of highly active antiretroviral therapy (HAART) during pregnancy.
DESIGN
Multicenter observational study. (ClinicalTrial.gov: NCT00028145).
SETTING
67 U.S. AIDS clinical research sites.
PATIENTS
Pregnant women with HIV who initiated HAART during pregnancy.
MEASUREMENTS
Descriptive summaries and associations among sociodemographic, HIV disease, and treatment characteristics; pregnancy-related risk factors; and detectable VL (>400 copies/mL) at delivery.
RESULTS
Between 2002 and 2011, 671 women met inclusion criteria and 13.1% had detectable VL at delivery. Factors associated with detectable VL included multiparity (16.4% vs. 8.0% nulliparity; P = 0.002), black ethnicity (17.6% vs. 6.6% Hispanic and 6.6% white; P < 0.001), 11th grade education or less (17.6% vs. 12.1% had a high school diploma; P = 0.013), initiation of HAART in the third trimester (23.9% vs. 12.3% and 8.6% in the second and trimesters, respectively; P = 0.003), having an HIV diagnosis before the current pregnancy (16.1% vs. 11.0% during the current pregnancy; P = 0.051), and having the first prenatal visit in the third trimester (33.3% vs. 14.3% and 10.5% in the second and third trimesters, respectively; P = 0.002). Women who had treatment interruptions or reported poor medication adherence were more likely to have detectable VL at delivery.
LIMITATION
Data on many covariates were incomplete because women entered the study at varying times during pregnancy.
CONCLUSION
A total of 13.1% of women who initiated HAART during pregnancy had detectable VL at delivery. The timing of HAART initiation and prenatal care, along with medication adherence during pregnancy, were associated with detectable VL at delivery. Social factors, including ethnicity and education, may help identify women who could benefit from focused efforts to promote early HAART initiation and adherence.
PRIMARY FUNDING SOURCE
U.S. Department of Health and Human Services.
背景
高病毒载量（HIV-1 RNA）是母婴传播和产妇健康不良的危险因素。
目的
确定尽管在怀孕期间开始高效抗逆转录病毒治疗（HAART），但仍在分娩时检测到 HIV-1 RNA 的相关因素。
设计
多中心观察性研究。（ClinicalTrials.gov：NCT00028145）。
地点
美国 67 个艾滋病临床研究地点。
患者
在怀孕期间开始 HAART 的 HIV 孕妇。
测量方法
描述性总结以及社会人口统计学、HIV 疾病和治疗特征；与妊娠相关的危险因素；以及分娩时可检测到的 VL（>400 拷贝/ml）。
结果
2002 年至 2011 年期间，共有 671 名符合纳入标准的妇女，其中 13.1%在分娩时检测到 HIV-1 RNA。与可检测到的 VL 相关的因素包括多胎妊娠（16.4%比 8.0%的初产妇；P=0.002）、黑人种族（17.6%比 6.6%的西班牙裔和 6.6%的白人；P<0.001）、11 年级及以下教育程度（17.6%比 12.1%有高中文凭；P=0.013）、第三孕期开始 HAART（23.9%比第二和第三孕期的 12.3%和 8.6%；P=0.003）、当前妊娠前 HIV 诊断（16.1%比当前妊娠期间的 11.0%；P=0.051）以及第三个孕期的首次产前检查（33.3%比第二和第三个孕期的 14.3%和 10.5%；P=0.002）。有治疗中断或报告药物依从性差的妇女在分娩时更有可能检测到 HIV-1 RNA。
局限性
由于妇女在妊娠的不同时间进入研究，因此许多协变量的数据并不完整。
结论
在怀孕期间开始 HAART 的妇女中，有 13.1%在分娩时检测到 HIV-1 RNA。HAART 开始时间和产前护理，以及怀孕期间的药物依从性，与分娩时可检测到的 HIV-1 RNA 相关。社会因素，包括种族和教育程度，可能有助于识别那些可能受益于集中努力促进早期 HAART 启动和依从性的妇女。
主要资金来源
美国卫生与公众服务部。
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