1 Center for Biostatistics in AIDS Research , Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
2 Department of Biostatistics, Harvard T.H. Chan School of Public Health , Boston, Massachusetts.
AIDS Patient Care STDS. 2018 Feb;32(2):48-57. doi: 10.1089/apc.2017.0295.
Postnatal antiretroviral (ARV) prophylaxis for infants born to women with HIV is a critical component of perinatal HIV transmission prevention. However, variability in prophylaxis regimens remains and consistency with guidelines has not been evaluated in the United States. We evaluated trends over time in prophylaxis regimens among 6386 HIV-exposed uninfected (HEU) infants using pooled data spanning two decades from three US-based cohorts: the Women and Infants Transmission Study (WITS, 1990-2007), Pediatric AIDS Clinical Trials Group (PACTG) 219C (1993-2007), and the PHACS Surveillance Monitoring of ART Toxicities (SMARTT) study (2007-2015). We also identified maternal and infant risk factors for use of combination prophylaxis regimens (≥2 ARVs) and examined consistency with US perinatal guidelines. We found that receipt of combination prophylaxis between 1996 and 2015 ranged from 2% to 15%, with a consistent median duration of 6 weeks. Infants whose mothers had lower CD4 T-cell counts, higher viral load (VL), no antepartum ARVs, age <20 years at delivery, and Cesarean delivery had significantly higher rates of combination prophylaxis, while infants born 2006-2010 (vs. 2011-2015), who were Hispanic or with lower maternal education levels, had significantly lower rates. Predictors for combination prophylaxis varied over time, with the strongest associations of maternal VL in later birth cohorts. While use of combination prophylaxis increased over time, only 50% of high-risk infants received such regimens in 2011-2015. In conclusion, HEU infants at higher risk of HIV acquisition are more likely to receive combination neonatal prophylaxis, consistent with US guidelines. However, substantial variability remains, and infants at higher risk often fail to receive combination prophylaxis.
对感染 HIV 的妇女所生婴儿进行产后抗逆转录病毒（ARV）预防是围产期 HIV 传播预防的重要组成部分。然而，预防方案仍存在差异，并且尚未在美国评估其与指南的一致性。我们使用来自三个美国队列的二十年合并数据，评估了 6386 名 HIV 暴露但未感染（HEU）婴儿的预防方案随时间的变化趋势：妇女和婴儿传播研究（WITS，1990-2007 年），儿科艾滋病临床试验组（PACTG）219C（1993-2007 年）和 PHACS 抗逆转录病毒毒性监测（SMARTT）研究（2007-2015 年）。我们还确定了使用联合预防方案（≥2 种 ARV）的母婴危险因素，并检查了其与美国围产期指南的一致性。我们发现，1996 年至 2015 年间，联合预防的使用率在 2%至 15%之间，中位持续时间为 6 周。母亲 CD4 T 细胞计数较低、病毒载量（VL）较高、无产前 ARV、分娩时年龄<20 岁和剖宫产的婴儿，接受联合预防的比例显著较高，而 2006-2010 年（与 2011-2015 年）出生的婴儿、西班牙裔或母亲受教育程度较低的婴儿，接受联合预防的比例显著较低。联合预防的预测因素随时间而变化，与后期出生队列中母亲 VL 的最强相关性。虽然联合预防的使用率随时间增加，但在 2011-2015 年，只有 50%的高危婴儿接受了这种方案。总之，感染 HIV 风险较高的 HEU 婴儿更有可能接受联合新生儿预防，这与美国指南一致。然而，仍存在较大差异，且高风险婴儿通常无法接受联合预防。
