Matthews Lynn T, Ribaudo Heather B, Kaida Angela, Bennett Kara, Musinguzi Nicholas, Siedner Mark J, Kabakyenga Jerome, Hunt Peter W, Martin Jeffrey N, Boum Yap, Haberer Jessica E, Bangsberg David R
*Division of Infectious Disease, Center for Global Health, Massachusetts General Hospital, Boston, MA; †Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, MA; ‡Faculty of Health Sciences, Simon Fraser University, Burnaby BC, Canada; §Bennett Statistical Consulting, Ballston Lake, NY; ‖Mbarara University of Science and Technology, Mbarara, Uganda; Departments of ¶Medicine, and #Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CA; **Epicentre Mbarara, Mbarara, Uganda; ††Department of General Medicine, Center for Global Health, Massachusetts General Hospital, Boston, MA.
J Acquir Immune Defic Syndr. 2016 Apr 1;71(4):399-406. doi: 10.1097/QAI.0000000000000874.
BACKGROUND: HIV-infected women risk sexual and perinatal HIV transmission during conception, pregnancy, childbirth, and breastfeeding. We compared HIV-1 RNA suppression and medication adherence across periconception, pregnancy, and postpartum periods, among women on antiretroviral therapy (ART) in Uganda. METHODS: We analyzed data from women in a prospective cohort study, aged 18-49 years, enrolled at ART initiation and with ≥1 pregnancy between 2005 and 2011. Participants were seen quarterly. The primary exposure of interest was pregnancy period, including periconception (3 quarters before pregnancy), pregnancy, postpartum (6 months after pregnancy outcome), or nonpregnancy related. Regression models using generalized estimating equations compared the likelihood of HIV-1 RNA ≤400 copies per milliliter, <80% average adherence based on electronic pill caps (medication event monitoring system), and likelihood of 72-hour medication gaps across each period. RESULTS: One hundred eleven women contributed 486 person-years of follow-up. Viral suppression was present at 89% of nonpregnancy, 97% of periconception, 93% of pregnancy, and 89% of postpartum visits, and was more likely during periconception (adjusted odds ratio, 2.15) compared with nonpregnant periods. Average ART adherence was 90% [interquartile range (IQR), 70%-98%], 93% (IQR, 82%-98%), 92% (IQR, 72%-98%), and 88% (IQR, 63%-97%) during nonpregnant, periconception, pregnant, and postpartum periods, respectively. Average adherence <80% was less likely during periconception (adjusted odds ratio, 0.68), and 72-hour gaps per 90 days were less frequent during periconception (adjusted relative risk, 0.72) and more frequent during postpartum (adjusted relative risk, 1.40). CONCLUSIONS: Women with pregnancy were virologically suppressed at most visits, with an increased likelihood of suppression and high adherence during periconception follow-up. Increased frequency of 72-hour gaps suggests a need for increased adherence support during postpartum periods.
背景：感染HIV的女性在受孕、怀孕、分娩和母乳喂养期间存在性传播和围产期HIV传播的风险。我们比较了乌干达接受抗逆转录病毒治疗（ART）的女性在受孕前、孕期和产后期间的HIV-1 RNA抑制情况及药物依从性。 方法：我们分析了一项前瞻性队列研究中女性的数据，这些女性年龄在18至49岁之间，在开始接受ART治疗时入组，且在2005年至2011年期间至少有过1次怀孕。参与者每季度接受一次检查。主要关注的暴露因素是孕期，包括受孕前（怀孕前3个季度）、孕期、产后（怀孕结局后6个月）或与非怀孕相关。使用广义估计方程的回归模型比较了每个时期HIV-1 RNA≤400拷贝/毫升的可能性、基于电子药帽（药物事件监测系统）的平均依从性<80%的情况以及每90天出现72小时药物漏服的可能性。 结果：111名女性提供了486人年的随访数据。在非孕期就诊时病毒抑制率为89%，受孕前为97%，孕期为93%，产后为89%，与非孕期相比，受孕前病毒抑制的可能性更高（调整后的优势比为2.15）。非孕期、受孕前、孕期和产后期间的平均ART依从性分别为90%[四分位间距（IQR），70%-98%]、93%（IQR，82%-98%）、92%（IQR，72%-98%）和88%（IQR，63%-97%）。受孕前平均依从性<80%的可能性较小（调整后的优势比为0.68），每90天出现72小时漏服的情况在受孕前较少（调整后的相对风险为0.72），而在产后较多（调整后的相对风险为1.40）。 结论：怀孕女性在大多数就诊时病毒得到抑制，受孕前随访期间病毒抑制和高依从性的可能性增加。72小时漏服频率增加表明产后期间需要加强依从性支持。
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