Rahangdale Lisa, Cates Jordan, Potter JoNell, Badell Martina L, Seidman Dominika, Miller Emilly S, Coleman Jenell S, Lazenby Gweneth B, Levison Judy, Short William R, Yawetz Sigal, Ciaranello Andrea, Livingston Elizabeth, Duthely Lunthita, Rimawi Bassam H, Anderson Jean R, Stringer Elizabeth M
Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC.
Department of Epidemiology, University of North Carolina Gillings School of Public Health, Chapel Hill, NC.
Am J Obstet Gynecol. 2016 Mar;214(3):385.e1-7. doi: 10.1016/j.ajog.2015.12.052.
Minimizing time to HIV viral suppression is critical in pregnancy. Integrase strand transfer inhibitors (INSTIs), like raltegravir, are known to rapidly suppress plasma HIV RNA in nonpregnant adults. There are limited data in pregnant women.
We describe time to clinically relevant reduction in HIV RNA in pregnant women using INSTI-containing and non-INSTI-containing antiretroviral therapy (ART) options.
We conducted a retrospective cohort study of pregnant HIV-infected women in the United States from 2009 through 2015. We included women who initiated ART, intensified their regimen, or switched to a new regimen due to detectable viremia (HIV RNA >40 copies/mL) at ≥20 weeks gestation. Among women with a baseline HIV RNA permitting 1-log reduction, we estimated time to 1-log RNA reduction using the Kaplan-Meier estimator comparing women starting/adding an INSTI in their regimen vs other ART. To compare groups with similar follow-up time, we also conducted a subgroup analysis limited to women with ≤14 days between baseline and follow-up RNA data.
This study describes 101 HIV-infected pregnant women from 11 US clinics. In all, 75% (76/101) of women were not taking ART at baseline; 24 were taking non-INSTI containing ART, and 1 received zidovudine monotherapy. In all, 39% (39/101) of women started an INSTI-containing regimen or added an INSTI to their ART regimen. Among 90 women with a baseline HIV RNA permitting 1-log reduction, the median time to 1-log RNA reduction was 8 days (interquartile range [IQR], 7-14) in the INSTI group vs 35 days (IQR, 20-53) in the non-INSTI ART group (P < .01). In a subgroup of 39 women with first and last RNA measurements ≤14 days apart, median time to 1-log reduction was 7 days (IQR, 6-10) in the INSTI group vs 11 days (IQR, 10-14) in the non-INSTI group (P < .01).
ART that includes INSTIs appears to induce more rapid viral suppression than other ART regimens in pregnancy. Inclusion of an INSTI may play a role in optimal reduction of HIV RNA for HIV-infected pregnant women presenting late to care or failing initial therapy. Larger studies are urgently needed to assess the safety and effectiveness of this approach.
在孕期尽量缩短实现HIV病毒抑制的时间至关重要。整合酶链转移抑制剂（INSTIs），如拉替拉韦，已知可在非妊娠成人中迅速抑制血浆HIV RNA。但关于孕妇的数据有限。
我们描述了使用含INSTI和不含INSTI的抗逆转录病毒疗法（ART）方案的孕妇实现临床相关HIV RNA降低所需的时间。
我们对2009年至2015年在美国感染HIV的孕妇进行了一项回顾性队列研究。纳入了在妊娠≥20周时因可检测到病毒血症（HIV RNA>40拷贝/mL）而开始ART、强化治疗方案或改用新方案的妇女。在基线HIV RNA允许降低1个对数的妇女中，我们使用Kaplan-Meier估计器比较开始/添加INSTI到其治疗方案的妇女与其他ART方案的妇女，估计实现RNA降低1个对数的时间。为了比较随访时间相似的组，我们还进行了一项亚组分析，仅限于基线和随访RNA数据间隔≤14天的妇女。
本研究描述了来自美国11家诊所的101名感染HIV的孕妇。总体而言，75%（76/101）的妇女在基线时未接受ART；24名妇女接受不含INSTI的ART，1名妇女接受齐多夫定单药治疗。总体而言，39%（39/101）的妇女开始使用含INSTI的方案或在其ART方案中添加了INSTI。在90名基线HIV RNA允许降低1个对数的妇女中，INSTI组实现RNA降低1个对数的中位时间为8天（四分位间距[IQR]，7 - 14），而非INSTI ART组为35天（IQR，20 - 53）（P <.01）。在首次和末次RNA测量间隔≤14天的39名妇女亚组中，INSTI组实现降低1个对数的中位时间为7天（IQR，6 - 10），而非INSTI组为11天（IQR，10 - 14）（P <.01）。
在孕期，包含INSTIs的ART方案似乎比其他ART方案能诱导更快的病毒抑制。对于就诊较晚或初始治疗失败的感染HIV的孕妇，添加INSTI可能在最佳降低HIV RNA方面发挥作用。迫切需要开展更大规模的研究来评估这种方法的安全性和有效性。
