Scott Rachel K, Chakhtoura Nahida, Burke Margaret M, Cohen Rachel A, Kreitchmann Regis
MedStar Health Research Institute and MedStar Washington Hospital Center, Washington, DC; the Maternal and Pediatric Infectious Disease Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland; Women's and Infants' Services, MedStar Washington Hospital Center, Washington, DC; Westat, Rockville, Maryland; and the International Site Development Initiative Perinatal/Longitudinal Study in Latin American Countries Protocol, Irmandade da Santa Casa de Misericordia de Porto Alegre, Universidade Federal das Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil.
Obstet Gynecol. 2017 Sep;130(3):502-510. doi: 10.1097/AOG.0000000000002186.
To evaluate whether there is increased mother-to-child transmission of human immunodeficiency virus (HIV)-1 associated with deliveries at 40 weeks of estimated gestational age (EGA) or greater in pregnant women with HIV-1 viral loads of 1,000 copies/mL or less.
We performed a secondary analysis of the Eunice Kennedy Shriver National Institute of Child Health and Human Development International Site Development Initiative Perinatal and Longitudinal Study in Latin American Countries and International Maternal Pediatric Adolescent AIDS Clinical Trials P1025 cohorts. We included pregnant women with HIV-1 with recent viral loads of 1,000 copies/mL or less at the time of delivery and compared delivery outcomes at between 38 and less than 40 weeks EGA with delivery outcomes at 40 weeks EGA or greater, the exposure of interest. Our primary outcome of interest was mother-to-child transmission, and secondary outcomes included indicators of maternal and neonatal morbidity. We examined the association between EGA and mother-to-child transmission using Poisson distribution. Associations between EGA and secondary outcomes were examined through bivariate analyses using Pearson χ and Fisher exact test or the nonparametric Mann-Whitney U test.
Among the 2,250 eligible neonates, eight neonates were infected with HIV-1 (overall transmission rate 0.4%, 95% CI 0.2-8.1%, 40 weeks EGA or greater 0.5% [3/621, 95% CI 0.2-1.4%], less than 40 weeks EGA 0.3% [5/1,629, 95% CI 0.1-0.7%]); there was no significant difference in transmission by EGA (rate ratio 1.57, 95% CI 0.24-8.09, P=.77). There was no difference in maternal viral load between the two groups nor was there a difference in timing of transmission among neonates born with HIV-1.
In pregnant women with well-controlled HIV-1, the risk of mother-to-child transmission did not differ significantly by EGA at delivery, although we were not powered to demonstrate equivalence of proportions of mother-to-child transmission between EGA groups.
评估在妊娠估计孕周（EGA）40周及以上分娩的、人类免疫缺陷病毒1型（HIV-1）病毒载量为1000拷贝/mL或更低的孕妇中，HIV-1的母婴传播是否增加。
我们对尤妮斯·肯尼迪·施赖弗国家儿童健康与人类发展研究所拉丁美洲国家围产期和纵向研究国际站点发展倡议队列以及国际母婴儿科青少年艾滋病临床试验P1025队列进行了二次分析。我们纳入了分娩时HIV-1病毒载量为1000拷贝/mL或更低的孕妇，并将38周及小于40周EGA时的分娩结局与40周及以上EGA时的分娩结局（感兴趣的暴露因素）进行比较。我们感兴趣的主要结局是母婴传播，次要结局包括孕产妇和新生儿发病指标。我们使用泊松分布研究EGA与母婴传播之间的关联。通过使用Pearson χ²和Fisher精确检验或非参数Mann-Whitney U检验的双变量分析来研究EGA与次要结局之间的关联。
在2250名符合条件的新生儿中，8名新生儿感染了HIV-1（总体传播率0.4%，95%置信区间0.2 - 8.1%，40周及以上EGA为0.5%[3/621，95%置信区间0.2 - 1.4%]，小于40周EGA为0.3%[5/1629，95%置信区间0.1 - 0.7%]）；按EGA划分的传播率无显著差异（率比1.57，95%置信区间0.24 - 8.09，P = 0.77）。两组之间孕产妇病毒载量无差异，感染HIV-1的新生儿的传播时间也无差异。
在HIV-1得到良好控制的孕妇中，分娩时按EGA划分的母婴传播风险无显著差异，尽管我们没有足够的能力证明EGA组之间母婴传播比例的等效性。
