人类免疫缺陷病毒病毒载量在先前抑制的、接受联合抗逆转录病毒治疗的孕妇分娩附近反弹。

Human Immunodeficiency Virus Viral Load Rebound Near Delivery in Previously Suppressed, Combination Antiretroviral Therapy-Treated Pregnant Women.

机构信息

Departments of Obstetrics and Gynaecology and Medicine, University of British Columbia, the Women's Health Research Institute, BC Women's Hospital and Health Centre, and the British Columbia Centre for Excellence for HIV/AIDS, Vancouver, British Columbia, Canada.

出版信息

Obstet Gynecol. 2017 Sep;130(3):497-501. doi: 10.1097/AOG.0000000000002133.

DOI:10.1097/AOG.0000000000002133

PMID:28796673

Abstract

OBJECTIVE

To assess the stability of human immunodeficiency virus (HIV) viral load suppression within 1 month before birth in pregnant women receiving antenatal combination antiretroviral therapy (CART).

METHODS

This is a retrospective cohort study of a Canadian provincial perinatal HIV database from 1997 to 2015. Inclusion criteria were live birth and CART received for at least 4 weeks. Viral load rebound, defined as viral load greater than 50 copies/mL (or greater than 400 copies/mL for 1997-1998) and measured within 1 month before delivery, was identified in women who had at least one previous undetectable viral load during pregnancy. Logistic regressions were conducted to identify the risk factors for viral load rebound.

RESULTS

Among the 470 women in the database, 318 met inclusion criteria. Viral load rebound was experienced by 19 women (6.0%, 95% CI 3.7-9.3%) with a mean log10 viral load near delivery of 2.71 copies/mL (=513 copies/mL). Six (32%) had a viral load above 1,000 copies/mL. The rebound was detected within 1 day before delivery in 50% of the women. Aboriginal ethnicity, cocaine use, and hepatitis C virus polymerase chain reaction positivity were significantly associated with viral load rebound. There were no HIV vertical transmissions.

CONCLUSION

Even women attending for HIV care and achieving viral suppression in pregnancy can experience viral load rebound predelivery.

摘要

目的

评估在接受产前联合抗逆转录病毒治疗（CART）的孕妇中，在分娩前 1 个月内人类免疫缺陷病毒（HIV）病毒载量抑制的稳定性。

方法

这是一项对加拿大省级围产期 HIV 数据库进行的回顾性队列研究，时间为 1997 年至 2015 年。纳入标准为活产和至少接受 4 周 CART。病毒载量反弹定义为病毒载量大于 50 拷贝/mL（1997-1998 年为大于 400 拷贝/mL），并在分娩前 1 个月内测量。在至少有一次妊娠期间检测到不可检测的病毒载量的妇女中确定了病毒载量反弹。进行逻辑回归以确定病毒载量反弹的危险因素。

结果

在数据库中的 470 名妇女中，有 318 名符合纳入标准。19 名妇女（6.0%，95%CI 3.7-9.3%）经历了病毒载量反弹，接近分娩时的平均对数 10 病毒载量为 2.71 拷贝/mL（=513 拷贝/mL）。其中 6 名（32%）病毒载量高于 1000 拷贝/mL。50%的妇女在分娩前 1 天内检测到反弹。土著民族、可卡因使用和丙型肝炎病毒聚合酶链反应阳性与病毒载量反弹显著相关。没有 HIV 垂直传播。