Africa Health Research Institute, KwaZulu-Natal, South Africa.
Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, KwaZulu-Natal, South Africa.
Trop Med Int Health. 2018 Jan;23(1):79-91. doi: 10.1111/tmi.13001. Epub 2017 Nov 28.
Pregnancy and post-partum viral load suppression is critical to prevent mother-to-child HIV transmission and ensure maternal health. We measured viraemia risk before, during and after pregnancy in HIV-infected women.
Between 2010 and 2015, 1425 HIV-infected pregnant women on lifelong antiretroviral therapy (ART) for at least six months pre-pregnancy were enrolled in a cohort study in rural KwaZulu-Natal, South Africa. Odds ratios were estimated in multilevel logistic regression, with pregnancy period time-varying.
Over half of 1425 women received tenofovir-based regimens (n = 791). Median pre-pregnancy ART duration was 2.1 years. Of 988 women (69.3%) with pre-pregnancy viral loads, 82.0%, 6.8% and 11.2% had VL <50, 50-999 and ≥1000 copies/ml, respectively. During pregnancy and at six, 12 and 24 months, viral load was ≥1000 copies/ml in 15.2%, 15.7%, 17.8% and 16.6% respectively; viral load <50 was 76.9%, 77%, 75.5% and 75.8%, respectively. Adjusting for age, clinical and pregnancy factors, viraemia risk (viral load ≥50 copies/ml) was not significantly associated with pregnancy [adjusted OR (aOR) 1.31; 95% CI 0.90-1.92], six months (aOR 1.30; 95% CI 0.83-2.04), 12 months (aOR 0.96; 95% CI 0.58-1.58) and 24 months (aOR 1.40; 95% CI 0.89-2.22) post-partum. Adjusting for ART duration-pregnancy period interaction, viraemia risk was 1.8 during pregnancy and twofold higher post-partum.
While undetectable viral load before pregnancy through post-partum was common, the UNAIDS goal to suppress viraemia in 90% of women was not met. Women on preconception ART remain vulnerable to viraemia; additional support is required to prevent mother-to-child HIV transmission and maintain maternal health.
妊娠和产后病毒载量抑制对于预防母婴 HIV 传播和确保母婴健康至关重要。我们测量了感染 HIV 的妇女在妊娠前后的病毒血症风险。
在 2010 年至 2015 年期间，在南非夸祖鲁-纳塔尔省农村地区，对 1425 名接受至少六个月终身抗逆转录病毒治疗（ART）的感染 HIV 的孕妇进行了一项队列研究。采用多水平逻辑回归估计比值比，孕期时间为变量。
超过一半的 1425 名妇女接受了基于替诺福韦的方案（n=791）。中位妊娠前 ART 持续时间为 2.1 年。在 988 名（69.3%）有妊娠前病毒载量的妇女中，分别有 82.0%、6.8%和 11.2%的 VL<50、50-999 和≥1000 拷贝/ml。在妊娠期间以及产后 6、12 和 24 个月时，VL≥1000 拷贝/ml 的比例分别为 15.2%、15.7%、17.8%和 16.6%；VL<50 的比例分别为 76.9%、77%、75.5%和 75.8%。调整年龄、临床和妊娠因素后，病毒血症风险（病毒载量≥50 拷贝/ml）与妊娠[调整比值比（aOR）1.31；95%置信区间（CI）0.90-1.92]、产后 6 个月（aOR 1.30；95% CI 0.83-2.04）、产后 12 个月（aOR 0.96；95% CI 0.58-1.58）和产后 24 个月（aOR 1.40；95% CI 0.89-2.22）无显著相关性。调整 ART 持续时间-妊娠期相互作用后，妊娠期间病毒血症风险为 1.8，产后增加一倍。
尽管妊娠前和产后的病毒载量检测不到是常见的，但实现联合国艾滋病规划署将 90%的妇女病毒载量抑制的目标仍未实现。接受孕前 ART 的妇女仍然容易发生病毒血症；需要额外的支持，以预防母婴 HIV 传播并维持母婴健康。
