Myer L, Phillips T K, McIntyre J A, Hsiao N-Y, Petro G, Zerbe A, Ramjith J, Bekker L-G, Abrams E J
Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa.
Anova Health Institute, Johannesburg, South Africa.
HIV Med. 2017 Feb;18(2):80-88. doi: 10.1111/hiv.12397. Epub 2016 Jun 28.
Maternal HIV viral load (VL) drives mother-to-child HIV transmission (MTCT) risk but there are few data from sub-Saharan Africa, where most MTCT occurs. We investigated VL changes during pregnancy and MTCT following antiretroviral therapy (ART) initiation in Cape Town, South Africa.
We conducted a prospective study of HIV-infected women initiating ART within routine antenatal services in a primary care setting. VL measurements were taken before ART initiation and up to three more times within 7 days postpartum. Analyses examined VL changes over time, viral suppression (VS) at delivery, and early MTCT based on polymerase chain reaction (PCR) testing up to 8 weeks of age.
A total of 620 ART-eligible HIV-infected pregnant women initiated ART, with 2425 VL measurements by delivery (median gestation at initiation, 20 weeks; median pre-ART VL, 4.0 log HIV-1 RNA copies/mL; median time on ART before delivery, 118 days). At delivery, 91% and 73% of women had VL ≤ 1000 and ≤ 50 copies/mL, respectively. VS was strongly predicted by time on therapy and pre-ART VL. The risk of early MTCT was strongly associated with delivery VL, with risks of 0.25, 2.0 and 8.5% among women with VL < 50, 50-1000 and > 1000 copies/mL at delivery, respectively (P < 0.001).
High rates of VS at delivery and low rates of MTCT can be achieved in a routine care setting in sub-Saharan Africa, indicating the effectiveness of currently recommended ART regimens. Women initiating ART late in pregnancy and with high VL appear substantially less likely to achieve VS and require targeted research and programmatic attention.
孕产妇艾滋病毒载量（VL）会影响母婴艾滋病毒传播（MTCT）风险，但在撒哈拉以南非洲地区（大多数MTCT发生于此），相关数据较少。我们在南非开普敦调查了孕期VL变化以及开始抗逆转录病毒治疗（ART）后的MTCT情况。
我们对在初级保健机构接受常规产前检查并开始ART的艾滋病毒感染女性进行了一项前瞻性研究。在开始ART前以及产后7天内最多再进行三次VL测量。分析考察了VL随时间的变化、分娩时的病毒抑制（VS）情况，以及基于聚合酶链反应（PCR）检测的8周龄以内婴儿的早期MTCT情况。
共有620名符合ART治疗条件的艾滋病毒感染孕妇开始接受ART治疗，分娩时共进行了2425次VL测量（开始治疗时的中位孕周为20周；ART治疗前的中位VL为4.0 log HIV-1 RNA拷贝/毫升；分娩前接受ART治疗的中位时间为118天）。分娩时，分别有91%和73%的女性VL≤1000和≤50拷贝/毫升。治疗时间和ART治疗前的VL强烈预测VS情况。早期MTCT风险与分娩时的VL密切相关，分娩时VL<50、50 - 1000和>1000拷贝/毫升的女性，其MTCT风险分别为0.25%、2.0%和8.5%（P<0.001）。
在撒哈拉以南非洲地区的常规护理环境中，可以实现较高的分娩时VS率和较低的MTCT率，这表明目前推荐的ART方案是有效的。妊娠晚期开始接受ART治疗且VL较高的女性实现VS的可能性明显较低，需要有针对性的研究和项目关注。
