1 Department of Obstetrics and Gynecology and University of Texas Southwestern Medical Center, Dallas, Texas.
2 Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.
AIDS Patient Care STDS. 2019 Jan;33(1):14-20. doi: 10.1089/apc.2018.0117.
Pregnant women living with HIV are at risk for loss to follow-up and viral rebound after delivery. We conducted a retrospective cohort study of women with HIV who delivered at Parkland Hospital, Dallas, to identify factors associated with postpartum loss to HIV care 1 year after delivery. Logistic regression was used to identify factors predicting loss to follow-up. For a subset of women, we compared odds of viremia detectable at delivery and postpartum among women with higher versus lower pill burden regimens. We included 604 women with HIV who delivered between 2005 and 2015. Three hundred ninety-one (65%) women completed at least one visit with an HIV provider within 1 year of delivery. The follow-up rate among black, non-Hispanic women was 65%; 57% for white, non-Hispanic women; and 78% for Hispanic women. Women without follow-up presented for prenatal care later (17 vs. 11 weeks, p < 0.001), and were less likely to be on antiretroviral therapy at initial prenatal visit (29% vs. 49%, p < 0.001). Factors predicting loss to follow-up in multivariate analysis included low-level viremia at delivery [adjusted odds ratio (aOR) = 2.85, 95% confidence interval (CI) = 1.73-4.71] and failure to return for a postpartum visit (aOR = 3.19, 95% CI = 2.07-4.94). High antiretroviral pill burden (≥6 pills daily) was associated with viremia (>1000 copies/mL) at the first prenatal visit (OR = 8.7, 95% CI = 4.6-16.6) through 1 year postpartum (OR = 2.3, 95% CI = 1.2-4.4). Viremia at delivery, failure to return for a postpartum visit, and high pill burden during pregnancy are predictors of postpartum loss to HIV care.
感染 HIV 的孕妇在分娩后有失去随访和病毒反弹的风险。我们对达拉斯帕克兰医院分娩的 HIV 感染孕妇进行了一项回顾性队列研究，以确定与分娩后 1 年 HIV 护理丢失相关的因素。采用逻辑回归来确定预测随访丢失的因素。对于一部分女性，我们比较了在分娩时和产后病毒载量可检测的女性中，药物负担较高与较低方案的女性之间的病毒载量可检测的几率。我们纳入了 2005 年至 2015 年期间分娩的 604 名 HIV 感染孕妇。391 名（65%）女性在分娩后 1 年内至少完成了一次与 HIV 提供者的就诊。黑人、非西班牙裔女性的随访率为 65%；白人、非西班牙裔女性为 57%；西班牙裔女性为 78%。未进行随访的女性初次产前检查时就诊时间较晚（17 周 vs. 11 周，p<0.001），初次产前就诊时接受抗逆转录病毒治疗的可能性较低（29% vs. 49%，p<0.001）。多变量分析中，预测随访丢失的因素包括分娩时低病毒载量[调整后的优势比（aOR）=2.85，95%置信区间（CI）=1.73-4.71]和未能返回进行产后就诊[aOR=3.19，95% CI=2.07-4.94]。高抗逆转录病毒药物负担（每天≥6 片）与首次产前就诊时的病毒载量（>1000 拷贝/mL）[比值比（OR）=8.7，95% CI=4.6-16.6]和产后 1 年的病毒载量相关[OR=2.3，95% CI=1.2-4.4]。分娩时病毒载量、未能返回进行产后就诊以及怀孕期间药物负担高是产后 HIV 护理丢失的预测因素。
