Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, Paris Descartes University, Paris, France.
Department of Infectious Diseases, AP-HP Hôpital Pitié-Salpêtrière, Paris-Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France.
J Acquir Immune Defic Syndr. 2018 Apr 15;77(5):439-450. doi: 10.1097/QAI.0000000000001618.
Chronic hepatitis B virus (HBV) or hepatitis C virus (HCV) infection is frequent in HIV-infected persons but their impact on pregnant HIV-infected women is understudied. We explored whether these coinfections are associated with adverse pregnancy outcomes and lower response to antiretroviral therapy (ART).
Pregnancies in HIV-1-infected women included in the ANRS French Perinatal Cohort between 2005 and 2013 were analyzed if HBV and HCV infection statuses were available.
Among 4236 women, the prevalence of HBV (HBs Ag+) and HCV (RNA+) were 6.2% (95% confidence interval: 5.4 to 6.8) and 1.7% (1.3 to 2.1), respectively. HCV coinfection was strongly associated with a history of drug use; HBV coinfection was 6 times more frequent in women born in Sub-Saharan Africa than in European France. Baseline HIV viral load, CD4 count, and HIV care during pregnancy were similar in coinfected and monoinfected HIV mothers, except that 90% of HBV/HIV women were receiving tenofovir and/or lamivudine or emtricitabine. HCV coinfection was significantly associated with cholestasis [adjusted odds ratio: 4.1 (1.5-10.8), P = 0.005], preterm delivery [3.0 (1.6-5.7), P < 0.001], lower CD4 [2.6 (1.0-6.4), P < 0.001], and detectable viral load [2.3 (1.0-5.5), P = 0.06] at the end of pregnancy. HBV coinfection was not associated with any of these outcomes.
In HIV-infected women, chronic HBV infection, mostly treated using targeted ART, had no major impact on the course of pregnancy. By contrast, chronic HCV infection was associated with a higher risk of obstetrical complications and a poorer immune-virological response to ART. It is yet unknown whether cure of HCV infection before conception can limit these adverse outcomes.
慢性乙型肝炎病毒（HBV）或丙型肝炎病毒（HCV）感染在 HIV 感染者中很常见，但它们对 HIV 感染孕妇的影响尚未得到充分研究。我们探讨了这些合并感染是否与不良妊娠结局和抗逆转录病毒治疗（ART）反应降低有关。
分析了 2005 年至 2013 年间参加法国 ANRS 围产期队列的 HIV-1 感染孕妇，如果可获得 HBV 和 HCV 感染状况，则纳入本研究。
在 4236 名妇女中，HBV（HBsAg+）和 HCV（RNA+）的流行率分别为 6.2%（95%置信区间：5.4 至 6.8）和 1.7%（1.3 至 2.1）。HCV 合并感染与药物使用史密切相关；与出生在欧洲法国的妇女相比，HBV 合并感染在撒哈拉以南非洲出生的妇女中更为常见（发病率比为 6 倍）。合并感染和单纯感染 HIV 的母亲的基线 HIV 病毒载量、CD4 计数和妊娠期间的 HIV 护理相似，但 90%的 HBV/HIV 妇女正在接受替诺福韦和/或拉米夫定或恩曲他滨治疗。HCV 合并感染与胆汁淤积症显著相关[校正优势比：4.1（1.5-10.8），P=0.005]、早产[3.0（1.6-5.7），P<0.001]、CD4 计数较低[2.6（1.0-6.4），P<0.001]和妊娠期末可检测到的病毒载量[2.3（1.0-5.5），P=0.06]。HBV 合并感染与这些结局均无关。
在 HIV 感染的女性中，慢性 HBV 感染（主要采用靶向 ART 治疗）对妊娠过程没有重大影响。相比之下，慢性 HCV 感染与产科并发症风险增加和 ART 免疫病毒学反应降低有关。尚不清楚在受孕前治愈 HCV 感染是否可以限制这些不良结局。
