Holtz Sara A, Thetard Rudi, Konopka Sarah N, Albertini Jennifer, Amzel Anouk, Fogg Karen P
Health Programs Group, 4301 North Fairfax Drive, Arlington, Virginia 22203, USA.
African Strategies for Health at Management Sciences for Health, 4301 North Fairfax Drive, Arlington, Virginia 22203, USA.
Int J MCH AIDS. 2015;4(2):11-24.
In high-prevalence populations, HIV-related maternal mortality is high with increased mortality found among HIV-infected pregnant and postpartum women compared to their uninfected peers. The scale-up of HIV-related treatment options and broader reach of programming for HIV-infected pregnant and postpartum women is likely to have decreased maternal mortality. This systematic review synthesized evidence on interventions that have directly reduced mortality among this population.
Studies published between January 1, 2003 and November 30, 2014 were searched using PubMed. Of the 1,373 records screened, 19 were included in the analysis.
Interventions identified through the review include antiretroviral therapy (ART), micronutrients (multivitamins, vitamin A, and selenium), and antibiotics. ART during pregnancy was shown to reduce mortality. Timing of ART initiation, duration of treatment, HIV disease status, and ART discontinuation after pregnancy influence mortality reduction. Incident pregnancy in women already on ART for their health appears not to have adverse consequences for the mother. Multivitamin use was shown to reduce disease progression while other micronutrients and antibiotics had no beneficial effect on maternal mortality.
ART was the only intervention identified that decreased death in HIV-infected pregnant and postpartum women. The findings support global trends in encouraging initiation of lifelong ART for all HIV-infected pregnant and breastfeeding women (Option B+), regardless of their CD4+ count, as an important step in ensuring appropriate care and treatment.
Maternal mortality is a rare event that highlights challenges in measuring the impact of interventions on mortality. Developing effective patient-centered interventions to reduce maternal morbidity and mortality, as well as corresponding evaluation measures of their impact, requires further attention by policy makers, program managers, and researchers.
在高流行人群中，与艾滋病毒相关的孕产妇死亡率很高，与未感染艾滋病毒的孕妇和产后妇女相比，感染艾滋病毒的孕妇和产后妇女的死亡率更高。扩大与艾滋病毒相关的治疗选择范围以及为感染艾滋病毒的孕妇和产后妇女提供更广泛的项目服务，可能降低了孕产妇死亡率。本系统评价综合了有关直接降低该人群死亡率的干预措施的证据。
使用PubMed检索2003年1月1日至2014年11月30日期间发表的研究。在筛选的1373条记录中，19条被纳入分析。
通过该评价确定的干预措施包括抗逆转录病毒疗法（ART）、微量营养素（多种维生素、维生素A和硒）以及抗生素。孕期接受抗逆转录病毒疗法可降低死亡率。开始抗逆转录病毒疗法的时间、治疗持续时间、艾滋病毒疾病状态以及产后停用抗逆转录病毒疗法会影响死亡率的降低。已因健康原因接受抗逆转录病毒疗法的妇女发生意外怀孕似乎对母亲没有不良后果。使用多种维生素可降低疾病进展，而其他微量营养素和抗生素对孕产妇死亡率没有有益影响。
抗逆转录病毒疗法是唯一被确定可降低感染艾滋病毒的孕妇和产后妇女死亡的干预措施。这些发现支持全球趋势，即鼓励所有感染艾滋病毒的孕妇和哺乳期妇女（选项B+）无论其CD4+细胞计数如何都开始终身抗逆转录病毒疗法，这是确保适当护理和治疗的重要一步。
孕产妇死亡是一个罕见事件，凸显了衡量干预措施对死亡率影响方面的挑战。制定以患者为中心的有效干预措施以降低孕产妇发病率和死亡率以及相应的影响评估措施，需要政策制定者、项目管理者和研究人员进一步关注。
