Mujugira Andrew, Baeten Jared, Kidoguchi Lara, Haberer Jessica, Celum Connie, Donnell Deborah, Ngure Kenneth, Bukusi Elizabeth, Mugo Nelly, Asiimwe Stephen, Odoyo Josephine, Tindimwebwa Edna, Bulya Nulu, Katabira Elly, Heffron Renee
University of Washington, Department of Global Health , 901 Boren Ave , Suite 1300 , Seattle, Washington, United States , 98104 ;
Seattle, United States ;
AIDS Res Hum Retroviruses. 2018 Feb;34(2):140-147. doi: 10.1089/aid.2017.0020. Epub 2017 Sep 13.
People who are asymptomatic and feel healthy, including pregnant women, may be less motivated to initiate ART or achieve high adherence. We assessed whether ART initiation, and viral suppression 6, 12 and 24-months after ART initiation, were lower in HIV-infected members of serodiscordant couples who initiated during pregnancy or with higher CD4 counts.
We used data from the Partners Demonstration Project, an open-label study of the delivery of integrated PrEP and ART (at any CD4 count) for HIV prevention among high-risk HIV serodiscordant couples in Kenya and Uganda. Differences in viral suppression (HIV RNA <400 copies/ml) among people initiating ART at different CD4 count levels (≤350, 351-500, and >500 cells/mm3) and during pregnancy were estimated using Poisson regression.
Of 865 HIV-infected participants retained after becoming eligible for ART during study follow-up, 95% initiated ART. Viral suppression 24-months after ART initiation was high overall (97%), and comparable among those initiating ART at CD4 counts >500, 351-500 and ≤350 cells/mm3 (96% vs 97% vs 97%; relative risk [RR] 0.98; 95% CI: 0.93-1.03 for CD4 >500 vs <350 and RR 0.99; 95% CI: (0.93-1.06) for CD4 351-500 vs ≤350). Viral suppression was as likely among women initiating ART primarily to prevent perinatal transmission as ART initiation for other reasons (p=0.9 at 6 months and p=0.5 at 12 months).
Nearly all HIV-infected partners initiating ART were virally suppressed by 24 months, irrespective of CD4 count or pregnancy status. These findings suggest that people initiating ART at high CD4 counts or due to pregnancy can adhere to ART as well as those starting treatment with symptomatic HIV disease or low CD4 counts.
包括孕妇在内无症状且自认为健康的人群，启动抗逆转录病毒治疗（ART）或实现高依从性的积极性可能较低。我们评估了在孕期启动ART或CD4细胞计数较高时启动ART的血清学不一致夫妇中，HIV感染成员的ART启动情况以及启动ART后6个月、12个月和24个月时的病毒抑制情况是否较低。
我们使用了来自伙伴示范项目的数据，这是一项在肯尼亚和乌干达针对高危HIV血清学不一致夫妇进行的开放标签研究，内容为提供综合暴露前预防（PrEP）和ART（在任何CD4细胞计数时）以预防HIV。使用泊松回归估计在不同CD4细胞计数水平（≤350、351 - 500和>500个细胞/mm³）以及孕期启动ART的人群中病毒抑制（HIV RNA<400拷贝/ml）的差异。
在研究随访期间符合ART资格后保留的865名HIV感染参与者中，95%启动了ART。ART启动后24个月时总体病毒抑制率较高（97%），在CD4细胞计数>500、351 - 500和≤350个细胞/mm³时启动ART的人群中相当（96%对97%对97%；相对风险[RR]0.98；CD4>500对比<350时95%置信区间：0.93 - 1.03，CD4 351 - 500对比≤350时RR 0.99；95%置信区间：0.93 - 1.06）。主要为预防围产期传播而启动ART的女性与因其他原因启动ART的女性病毒抑制情况相似（6个月时p = 0.9，12个月时p = 0.5）。
几乎所有启动ART的HIV感染伴侣在24个月时都实现了病毒抑制，无论CD4细胞计数或妊娠状态如何。这些发现表明，在CD4细胞计数较高时或因怀孕而启动ART的人群与因有症状的HIV疾病或低CD4细胞计数而开始治疗的人群一样，能够坚持ART治疗。
