From the School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
School of Public Health, University of Zambia, Lusaka, Zambia.
Pediatr Infect Dis J. 2018 Nov;37(11):1137-1141. doi: 10.1097/INF.0000000000001997.
Lifelong antiretroviral therapy (ART) is now recommended for all human immunodeficiency virus (HIV)-infected pregnant and breastfeeding women; however, few have described overall infant outcomes in this new era for the prevention of mother-to-child HIV transmission (PMTCT).
As part of an assessment of PMTCT program impact, we enrolled a prospective cohort study in 4 predominantly rural districts in Zambia. HIV-infected mothers and their newborns (≤30 days old) were recruited and followed at 6 weeks, 6 months and 12 months postpartum; infant specimens were tested via HIV DNA polymerase chain reaction. In Kaplan-Meier analyses, we estimated overall infant HIV-free survival and then stratified by district, community and maternal ART use. We investigated the relationship between community-level 12-month, self-reported maternal ART use and infant HIV-free survival via linear regression.
From June 2014 to November 2015, we enrolled 827 mother-infant pairs in 33 communities. At 12 months, small proportions of infants had died (2.8%), were HIV-infected (3.0%) or were lost to follow-up (4.3%). Overall, infant HIV-free survival was 99.0% [95% confidence interval (CI): 98.0%-99.5%] at 6 weeks, 97.5% (95% CI: 96.1%-98.4%) at 6 months and 96.3% (95% CI: 94.8%-97.4%) at 12 months. Women reporting ART use at enrollment had higher infant HIV-free survival than those who did not (97.4% vs. 89.0%, P = 0.01). Differences were noted at the district and site levels (P = 0.01). In community-level analysis, no relationship was observed between 12-month infant HIV-free survival and self-reported maternal ART use (P = 0.65).
Although encouraging, these findings highlight the need for rigorous monitoring and evaluation of PMTCT services at the population level.
目前建议所有感染人类免疫缺陷病毒（HIV）的孕妇和哺乳期妇女终生接受抗逆转录病毒治疗（ART）；然而，在预防母婴 HIV 传播（PMTCT）的新时代，很少有研究描述总体婴儿结局。
作为 PMTCT 项目影响评估的一部分，我们在赞比亚 4 个以农村为主的地区开展了一项前瞻性队列研究。招募 HIV 感染的母亲及其新生儿（≤30 天），在产后 6 周、6 个月和 12 个月时进行随访；通过 HIV DNA 聚合酶链反应检测婴儿样本。在 Kaplan-Meier 分析中，我们估计了总体婴儿 HIV 无存活情况，然后按区、社区和产妇 ART 使用情况进行分层。我们通过线性回归研究了社区层面上 12 个月时自我报告的产妇 ART 使用与婴儿 HIV 无存活之间的关系。
从 2014 年 6 月至 2015 年 11 月，我们在 33 个社区招募了 827 对母婴。在 12 个月时，婴儿死亡（2.8%）、HIV 感染（3.0%）或失访（4.3%）的比例很小。总体而言，6 周时婴儿 HIV 无存活的比例为 99.0%（95%CI：98.0%-99.5%），6 个月时为 97.5%（95%CI：96.1%-98.4%），12 个月时为 96.3%（95%CI：94.8%-97.4%）。在招募时报告使用 ART 的女性的婴儿 HIV 无存活比例高于未报告使用 ART 的女性（97.4% vs. 89.0%，P=0.01）。区和地点层面上存在差异（P=0.01）。在社区层面的分析中，12 个月时婴儿 HIV 无存活与自我报告的产妇 ART 使用之间没有观察到关系（P=0.65）。
尽管令人鼓舞，但这些发现突出表明需要在人群层面上严格监测和评估 PMTCT 服务。
