Department of Epidemiology, University of Washington, Seattle, Washington, United States of America.
Institute for Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya.
PLoS One. 2019 May 31;14(5):e0216252. doi: 10.1371/journal.pone.0216252. eCollection 2019.
The Option B+ strategy streamlines delivery of HIV antiretroviral therapy (ART) to pregnant women, but concerns remain about ART treatment adherence and long term outcomes.
We conducted a retrospective analysis of a cohort of HIV-positive, postpartum breastfeeding women receiving ART via Option B+ in Nairobi, Kenya. The primary outcome was virologic failure in plasma (HIV RNA >1000 copies/mL), and detection in breast milk (>150 copies/mL) and endocervical secretions (>100 copies/mL) at 2 postpartum timepoints. Correlates of virologic failure were assessed using univariate tests and multivariate logistic regression.
Of 42 women at 6-14 weeks postpartum, 21.4% of women had HIV RNA detected in plasma; 14.3% in breast milk, and 23.7% in endocervical secretions. At 18-24 weeks postpartum, the percentages were 21.1%, 7.1%, and 14.3%, respectively. Younger maternal age, intent to breastfeed for longer, and later ART start in pregnancy were significantly associated with plasma virologic failure (p < 0.05 for each). Odds of plasma virologic failure at 6-14 weeks postpartum were 1.25 times higher (95% CI 1.04, 1.51) for each increase in week of gestation at ART initiation. Only 3 women had resistance mutations to their regimen.
Despite months of ART, nearly one-quarter of the women in our cohort did not achieve plasma virologic suppression in the postpartum period. After adjusting for time on ART, earlier ART initiation in pregnancy was significantly associated with plasma suppression. Our findings suggest that postpartum HIV RNA monitoring in Option B+ programs will be needed to achieve elimination of MTCT.
Option B+ 策略简化了向孕妇提供艾滋病毒抗逆转录病毒疗法（ART）的流程，但人们仍然对 ART 治疗的依从性和长期结果存在担忧。
我们对肯尼亚内罗毕接受 Option B+ 的艾滋病毒阳性产后哺乳期妇女进行了一项回顾性分析。主要结局是在产后 2 个时间点血浆中病毒学失败（HIV RNA>1000 拷贝/毫升），以及在母乳（>150 拷贝/毫升）和宫颈分泌物（>100 拷贝/毫升）中检测到 HIV RNA。使用单变量检验和多变量逻辑回归评估病毒学失败的相关因素。
在产后 6-14 周的 42 名妇女中，21.4%的妇女血浆中检测到 HIV RNA；14.3%在母乳中，23.7%在宫颈分泌物中。在产后 18-24 周时，这一比例分别为 21.1%、7.1%和 14.3%。母亲年龄较小、母乳喂养时间较长和妊娠中晚期开始接受 ART 治疗与血浆病毒学失败显著相关（每个因素的 p<0.05）。与妊娠中开始 ART 的第 1 周相比，在第 6-14 周时，血浆病毒学失败的几率增加 1.25 倍（95%CI 1.04，1.51）。只有 3 名妇女对其方案的耐药性有突变。
尽管接受了数月的 ART，我们队列中的近四分之一妇女在产后期间仍未达到血浆病毒学抑制。在校正接受 ART 的时间后，妊娠中早期开始 ART 与血浆抑制显著相关。我们的研究结果表明，在 Option B+ 方案中需要进行产后 HIV RNA 监测，以实现消除母婴传播。
