1996年至2015年HIV门诊研究中女性孕期及产后的HIV RNA抑制情况
HIV RNA Suppression during and after Pregnancy among Women in the HIV Outpatient Study, 1996 to 2015.
作者信息
Patel Monita, Tedaldi Ellen, Armon Carl, Nesheim Steven, Lampe Margaret, Palella Frank, Novak Richard, Sutton Madeline, Buchacz Kate
机构信息
1 Centers for Disease Control and Prevention, Atlanta, GA, USA.
2 Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA.
出版信息
J Int Assoc Provid AIDS Care. 2018 Jan-Dec;17:2325957417752259. doi: 10.1177/2325957417752259.
OBJECTIVE
To examine HIV viral suppression during/after pregnancy.
DESIGN
Prospective observational cohort.
METHODS
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.
RESULTS
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).
CONCLUSIONS
Maintaining VL suppression among US women remains a challenge, particularly during postpartum. Achieving VL suppression earlier during pregnancy benefits women subsequently.
目的
研究孕期及产后的HIV病毒抑制情况。
设计
前瞻性观察队列研究。
方法
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）。
结果
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）。
结论
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。
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