UNC Project-Malawi, Kamuzu Central Hospital, Lilongwe, Malawi.
Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, United States of America.
PLoS One. 2018 Apr 3;13(4):e0195033. doi: 10.1371/journal.pone.0195033. eCollection 2018.
Effective antiretroviral therapy during pregnancy minimizes the risk of vertical HIV transmission. Some women present late in their pregnancy for first antenatal visit; whether these women achieve viral suppression by delivery and how suppression varies with time on ART is unclear.
We conducted a prospective cohort study of HIV-infected pregnant women initiating antiretroviral therapy for the first time at Bwaila Hospital in Lilongwe, Malawi from June 2015 to November 2016. Multivariable Poisson models with robust variance estimators were used to estimate risk ratios (RR) and 95% confidence intervals (CI) of the association between duration of ART and both viral load (VL) ≥1000 copies/ml and VL ≥40 copies/ml at delivery.
Of the 252 women who had viral load testing at delivery, 40 (16%) and 78 (31%) had VL ≥1000 copies/ml and VL ≥40 copies/ml, respectively. The proportion of women with poor adherence to ART was higher among women who were on ART for ≤12 weeks (9/50 = 18.0%) than among those who were on ART for 13-35 weeks (18/194 = 9.3%). Compared to women who were on ART for ≤12 weeks, women who were on ART for 13-20 weeks (RR = 0.52; 95% CI: 0.36-0.74) or 21-35 weeks (RR = 0.26; 95% CI: 0.14-0.48) had a lower risk of VL ≥40 copies/ml at delivery. Similar comparisons for VL ≥1000 copies/ml at delivery showed decrease in risk although not significant for those on ART 13-20 weeks.
Longer duration of ART during pregnancy was associated with suppressed viral load at delivery. Early ANC attendance in pregnancy to facilitate prompt ART initiation for HIV-positive women is essential in the effort to eliminate HIV vertical transmission.
在怀孕期间进行有效的抗逆转录病毒治疗可以最大限度地降低垂直传播 HIV 的风险。一些女性在妊娠晚期才首次进行产前检查；这些女性是否在分娩时实现病毒抑制，以及抑制程度随 ART 时间的变化如何尚不清楚。
我们对 2015 年 6 月至 2016 年 11 月在马拉维利隆圭的 Bwaila 医院首次接受抗逆转录病毒治疗的 HIV 感染孕妇进行了一项前瞻性队列研究。使用具有稳健方差估计的多变量泊松模型来估计 ART 持续时间与分娩时病毒载量（VL）≥1000 拷贝/ml 和 VL≥40 拷贝/ml 之间关联的风险比（RR）和 95%置信区间（CI）。
在 252 名分娩时进行病毒载量检测的女性中，分别有 40 名（16%）和 78 名（31%）的 VL≥1000 拷贝/ml 和 VL≥40 拷贝/ml。在 ART 治疗≤12 周的女性中，不良 ART 依从性的比例高于在 ART 治疗 13-35 周的女性（9/50=18.0%比 18/194=9.3%）。与 ART 治疗≤12 周的女性相比，ART 治疗 13-20 周（RR=0.52；95%CI：0.36-0.74）或 21-35 周（RR=0.26；95%CI：0.14-0.48）的女性分娩时 VL≥40 拷贝/ml 的风险较低。对于分娩时 VL≥1000 拷贝/ml 的类似比较显示，风险降低，但对于接受 13-20 周 ART 治疗的女性，风险降低并不显著。
妊娠期间 ART 持续时间较长与分娩时病毒载量受抑制有关。在努力消除 HIV 垂直传播的过程中，孕妇在妊娠早期进行 ANC 就诊，以促进 HIV 阳性妇女及时开始 ART 治疗，这是至关重要的。
