Hoffmann Christopher J, Cohn Silvia, Mashabela Fildah, Hoffmann Jennifer D, McIlleron Helen, Denti Paolo, Haas David W, Dooley Kelly E, Martinson Neil A, Chaisson Richard E
*Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD;†Perinatal HIV Research Unit (PHRU), University of the Witwatersrand, Soweto, South Africa;‡Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa; and§Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN.
J Acquir Immune Defic Syndr. 2016 Jan 1;71(1):31-7. doi: 10.1097/QAI.0000000000000811.
We assessed HIV RNA suppression, resistance, and CD4 T-cell count 12 months postpartum among pregnant women retained in care in an observational cohort study.
We prospectively followed two groups of HIV-infected pregnant women--with or without tuberculosis--recruited from prenatal clinics in South Africa. Women who received antiretroviral therapy during pregnancy and reported being on therapy 12 months postpartum were included. Serum samples from women with HIV viremia 12 months postpartum were tested for drug resistance.
Of 103 women in the study, median age and CD4 T-cell count at enrollment were 29 years [interquartile range (IQR): 26-32] and 317 cells per cubic millimeter (IQR: 218-385), respectively; 43 (42%) had tuberculosis at baseline. During pregnancy, 87% of the women achieved an HIV RNA <400 copies per milliliter compared with 71% at 12 months postpartum (P < 0.001). Factors independently associated with an HIV RNA <400 copies per milliliter at 12 months were age ≥ 30 years, detectable plasma efavirenz concentration, and HIV RNA <400 copies per milliliter while pregnant; there was a trend toward both a detectable viral load and peripartum depression. HIV drug resistance results were available from 25 women, and 12 (48%) had major drug resistance mutations. CD4 T-cell count declined a median of 13 cells per cubic millimeter (IQR: -66 to 140) from delivery to 12 months in women with viremia at 12 months.
Success with maintaining virologic control declined postpartum among HIV-infected women who remained in care and on antiretroviral therapy, and CD4 T-cell count decline and drug resistance were common.
在一项观察性队列研究中，我们评估了产后12个月接受护理的孕妇的HIV RNA抑制情况、耐药性及CD4 T细胞计数。
我们前瞻性地跟踪了两组从南非产前诊所招募的感染HIV的孕妇，一组有结核病，另一组没有。纳入孕期接受抗逆转录病毒治疗且报告产后12个月仍在接受治疗的女性。对产后12个月HIV病毒血症女性的血清样本进行耐药性检测。
研究中的103名女性，入组时的中位年龄和CD4 T细胞计数分别为29岁[四分位间距（IQR）：26 - 32]和每立方毫米317个细胞（IQR：218 - 385）；43名（42%）在基线时患有结核病。孕期，87%的女性HIV RNA降至每毫升<400拷贝，而产后12个月时为71%（P < 0.001）。与产后12个月HIV RNA<每毫升400拷贝独立相关的因素包括年龄≥30岁、血浆依非韦伦浓度可检测到、孕期HIV RNA<每毫升400拷贝；病毒载量可检测到和围产期抑郁均有一定趋势。25名女性有HIV耐药结果，其中12名（48%）有主要耐药突变。产后12个月有病毒血症的女性，从分娩到产后12个月，CD4 T细胞计数中位下降每立方毫米13个细胞（IQR： - 66至140）。
在接受护理并接受抗逆转录病毒治疗的HIV感染女性中，产后维持病毒学控制的成功率下降，CD4 T细胞计数下降和耐药情况常见。
