莫桑比克南部艾滋病毒感染对孕产妇和新生儿健康的影响：抗逆转录病毒药物推广十年后的前瞻性队列研究
Effects of HIV infection on maternal and neonatal health in southern Mozambique: A prospective cohort study after a decade of antiretroviral drugs roll out.
作者信息
González Raquel, Rupérez María, Sevene Esperança, Vala Anifa, Maculuve Sónia, Bulo Helder, Nhacolo Arsénio, Mayor Alfredo, Aponte John J, Macete Eusébio, Menendez Clara
机构信息
ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.
Manhiça Health Research Center (CISM), Manhiça, Mozambique.
出版信息
PLoS One. 2017 Jun 2;12(6):e0178134. doi: 10.1371/journal.pone.0178134. eCollection 2017.
INTRODUCTION
The HIV epidemic is concentrated in sub-Saharan Africa. However, limited information exists on its impact on women and infant's health since the introduction of antiretroviral drugs in this region, where health resources are often scarce.
METHODS
The effect of HIV infection on maternal health, birth outcomes and infant health was analysed in two contemporary cohorts of HIV-uninfected and HIV-infected pregnant women from southern Mozambique. Pregnant women attending the first antenatal care visit were followed until one month after delivery. Antiretroviral therapy was administered based on CD4+T cell count and clinical stage. Maternal and neonatal morbidity and mortality, as well as pregnancy outcomes were assessed by mother's HIV status.
RESULTS
A total of 1183 HIV-uninfected and 561 HIV-infected pregnant women were enrolled. HIV-infected women were more likely to have anaemia both at the first antenatal care visit and at delivery than HIV-uninfected women (71.5% versus 54.8% and 49.4% versus 40.6%, respectively, p<0.001). Incidence of hospital admissions during pregnancy was increased among HIV-infected women (RR, 2.04, [95%CI, 1.45; 2.86]; p<0.001). At delivery, 21% of HIV-infected women reported being on antiretroviral therapy, and 70% having received antiretroviral drugs for prevention of mother to child transmission of HIV. The risk of stillbirths was doubled in HIV-infected women (RR, 2.16 [95%CI 1.17; 3.96], p = 0.013). Foetal anaemia was also increased among infants born to HIV-infected women (10.6% versus 7.3%, p = 0.022). No differences were found in mean birth weight, malaria, prematurity and maternal and neonatal deaths between groups.
CONCLUSIONS
HIV infection continues to be associated with significant maternal morbidity and poor neonatal health outcomes. Efforts should urgently be made to identify the barriers that impede improvements on the devastating effects of HIV in African women and their infants.
TRIAL REGISTRATION
ClinicalTrials.gov NCT 00811421.
引言
艾滋病毒疫情集中在撒哈拉以南非洲地区。然而，自该地区引入抗逆转录病毒药物以来，关于其对妇女和婴儿健康影响的信息有限，该地区的卫生资源往往很稀缺。
方法
在莫桑比克南部两个当代队列中，对未感染艾滋病毒和感染艾滋病毒的孕妇进行分析，以研究艾滋病毒感染对孕产妇健康、分娩结局和婴儿健康的影响。对首次产前检查的孕妇进行随访，直至分娩后一个月。根据CD4+T细胞计数和临床分期给予抗逆转录病毒治疗。根据母亲的艾滋病毒感染状况评估孕产妇和新生儿的发病率和死亡率以及妊娠结局。
结果
共纳入1183名未感染艾滋病毒的孕妇和561名感染艾滋病毒的孕妇。与未感染艾滋病毒的妇女相比，感染艾滋病毒的妇女在首次产前检查时和分娩时患贫血的可能性更高（分别为71.5%对54.8%和49.4%对40.6%，p<0.001）。感染艾滋病毒的妇女孕期住院率增加（相对危险度，2.04，[95%置信区间，1.45；2.86]；p<0.001）。在分娩时，21%的感染艾滋病毒的妇女报告正在接受抗逆转录病毒治疗，70%的妇女接受了抗逆转录病毒药物以预防艾滋病毒母婴传播。感染艾滋病毒的妇女死产风险增加一倍（相对危险度，2.16 [95%置信区间1.17；3.96]，p = 0.013）。感染艾滋病毒的妇女所生婴儿中胎儿贫血也有所增加（10.6%对7.3%，p = 0.022）。两组之间在平均出生体重、疟疾、早产以及孕产妇和新生儿死亡方面未发现差异。
结论
艾滋病毒感染仍然与孕产妇的高发病率和不良的新生儿健康结局相关。应紧急努力确定阻碍改善艾滋病毒对非洲妇女及其婴儿造成的破坏性影响的障碍。
试验注册
ClinicalTrials.gov NCT 00811421。
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