Patel Monita, Tedaldi Ellen, Armon Carl, Nesheim Steven, Lampe Margaret, Palella Frank, Novak Richard, Sutton Madeline, Buchacz Kate
1 Centers for Disease Control and Prevention, Atlanta, GA, USA.
2 Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA.
J Int Assoc Provid AIDS Care. 2018 Jan-Dec;17:2325957417752259. doi: 10.1177/2325957417752259.
To examine HIV viral suppression during/after pregnancy.
Prospective observational cohort.
We identified pregnancies from 1996 to 2015. We examined HIV RNA viral load (VL), VL suppression (≤500 copies/mL), and antiretroviral therapy (ART) status at pregnancy start, end, and 6 months postpartum. We estimated risk ratios (RRs) and 95% confidence intervals (CIs) for VL nonsuppression.
Among 253 pregnancies analyzed, 34.8% of women exhibited VL suppression at pregnancy start, 60.1% at pregnancy end, and 42.7% at 6 months postpartum. Median VL (log copies/mL) was 2.80 (interquartile range [IQR]: 1.40-3.85) at pregnancy start, 1.70 (IQR: 1.40-2.82) at pregnancy end, and 2.30 (IQR: 1.40-3.86) at postpartum. Risk of postpartum VL nonsuppression was also lower among women on ART and with VL suppression at pregnancy end (versus those not; adjusted RR = 0.30, 95% CI: 0.17-0.53).
Maintaining VL suppression among US women remains a challenge, particularly during postpartum. Achieving VL suppression earlier during pregnancy benefits women subsequently.
研究孕期及产后的HIV病毒抑制情况。
前瞻性观察队列研究。
我们确定了1996年至2015年期间的妊娠情况。我们在妊娠开始、结束时以及产后6个月检查了HIV RNA病毒载量（VL）、病毒载量抑制情况（≤500拷贝/毫升）以及抗逆转录病毒治疗（ART）状态。我们估计了病毒载量未被抑制的风险比（RRs）和95%置信区间（CIs）。
在分析的253例妊娠中，34.8%的女性在妊娠开始时病毒载量得到抑制，60.1%在妊娠结束时得到抑制，42.7%在产后6个月得到抑制。妊娠开始时病毒载量中位数（log拷贝/毫升）为2.80（四分位间距[IQR]：1.40 - 3.85），妊娠结束时为1.70（IQR：1.40 - 2.82），产后为2.30（IQR：1.40 - 3.86）。在接受抗逆转录病毒治疗且妊娠结束时病毒载量得到抑制的女性中，产后病毒载量未被抑制的风险也较低（与未接受治疗及未得到抑制的女性相比；调整后的RR = 0.30，95% CI：0.17 - 0.53）。
在美国女性中维持病毒载量抑制仍然是一项挑战，尤其是在产后。孕期尽早实现病毒载量抑制对女性随后有益。
