Obstetrics-Gynecology Department, Hôpital Louis Mourier, Hôpitaux Universitaires Paris Nord Val de Seine, Assistance Publique-Hôpitaux de Paris, Colombes CESP, INSERM U1018 Université Paris Diderot Risks in Pregnancy University Department.
Infectious Diseases Department, Hôpital Pitié Salpétrière and Université Pierre et Marie Curie INSERM- UMR_S 943 Pierre Louis Institute of Epidemiology and Public Health.
Clin Infect Dis. 2015 Dec 1;61(11):1715-25. doi: 10.1093/cid/civ578. Epub 2015 Jul 21.
The efficacy of preventing perinatal transmission (PT) of human immunodeficiency virus type 1 (HIV-1) depends on both viral load (VL) and treatment duration. The objective of this study was to determine whether initiating highly active antiretroviral therapy (ART) before conception has the potential to eliminate PT.
A total of 8075 HIV-infected mother/infant pairs included from 2000 to 2011 in the national prospective multicenter French Perinatal Cohort (ANRS-EPF) received ART, delivered live-born children with determined HIV infection status, and did not breastfeed. PT was analyzed according to maternal VL at delivery and timing of ART initiation.
The overall rate of PT was 0.7% (56 of 8075). No transmission occurred among 2651 infants born to women who were receiving ART before conception, continued ART throughout the pregnancy, and delivered with a plasma VL <50 copies/mL (upper 95% confidence interval [CI], 0.1%). VL and timing of ART initiation were independently associated with PT in logistic regression. Regardless of VL, the PT rate increased from 0.2% (6 of 3505) for women starting ART before conception to 0.4% (3 of 709), 0.9% (24 of 2810), and 2.2% (23 of 1051) for those starting during the first, second, or third trimester (P < .001). Regardless of when ART was initiated, the PT rate was higher for women with VLs of 50-400 copies/mL near delivery than for those with <50 copies/mL (adjusted odds ratio, 4.0; 95% CI, 1.9-8.2).
Perinatal HIV-1 transmission is virtually zero in mothers who start ART before conception and maintain suppression of plasma VL.
预防人类免疫缺陷病毒 1 型（HIV-1）母婴垂直传播（PT）的疗效取决于病毒载量（VL）和治疗时间。本研究旨在确定在受孕前开始高效抗逆转录病毒治疗（ART）是否有潜力消除 PT。
共纳入 2000 年至 2011 年全国前瞻性多中心法国围产期队列（ANRS-EPF）的 8075 例 HIV 感染母婴对，均接受 ART 治疗，分娩出 HIV 感染状况明确的活产婴儿，且未进行母乳喂养。根据母亲分娩时的 VL 和 ART 启动时间分析 PT。
PT 的总体发生率为 0.7%（8075 例中的 56 例）。在 2651 例受孕前开始接受 ART、整个孕期持续接受 ART 且血浆 VL<50 拷贝/mL（上 95%置信区间[CI]，0.1%）的妇女所分娩的婴儿中，无一例发生传播。VL 和 ART 启动时间在逻辑回归中与 PT 独立相关。无论 VL 如何，在受孕前开始 ART 的妇女的 PT 率从 0.2%（3505 例中的 6 例）降至受孕时开始 ART 的妇女的 0.4%（709 例中的 3 例）、0.9%（2810 例中的 24 例）和 2.2%（1051 例中的 23 例）（P<0.001）。无论何时开始 ART，分娩时 VL 为 50-400 拷贝/mL 的妇女的 PT 率均高于 VL<50 拷贝/mL 的妇女（调整后的优势比，4.0；95%CI，1.9-8.2）。
在受孕前开始 ART 并维持血浆 VL 抑制的母亲中，母婴垂直传播 HIV-1 几乎为零。
