南非产前保健开始时和分娩时的 HIV 诊断时间、CD4 计数和病毒载量。

Time of HIV diagnosis, CD4 count and viral load at antenatal care start and delivery in South Africa.

机构信息

Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.

Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand and National Institute for Communicable Diseases, a division of the National Health Laboratory Service, Johannesburg, South Africa.

出版信息

PLoS One. 2020 Feb 13;15(2):e0229111. doi: 10.1371/journal.pone.0229111. eCollection 2020.

DOI:10.1371/journal.pone.0229111

PMID:32053679

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7018033/

Abstract

BACKGROUND

Despite the success of prevention of mother to child transmission (PMTCT) program in South Africa, the 30% HIV prevalence among women of childbearing age requires the PMTCT program to be maximally efficient to sustain gains in the prevention of vertical HIV transmission. We aimed to determine the immunologic and virologic status at entry into antenatal care (ANC) and at childbirth among HIV positive women who conceived under the CD4<500 cells/μl antiretroviral therapy (ART) eligibility threshold and universal test and treat (UTT) policies in the Gauteng province of South Africa.

METHOD

We conducted a retrospective cohort study of 692 HIV positive adult (>18 years) postpartum women who gave birth between September 2016 and December 2017. Demographic, viral load (VL) and CD4 data at ANC start (3-9 months before delivery) and delivery (3 months before/after) were obtained from medical records of consenting women. We compared CD4≥500 cell/μl and viral load (VL) suppression (<400 copes/ml) rates at ANC start and delivery among women with a pre-pregnancy ART, women known HIV positive but with in-pregnancy ART and newly diagnosed women with in-pregnancy ART. Predictors of having a high CD4 and suppressed VL were assessed by log-binomial regression.

RESULTS

Of the 692 participants, 394 (57.0%) had CD4 data and 326 (47.1%) had VL data. Overall women with a pre-pregnancy ART were more likely to start ANC with CD4 count≥500 cell/μl (46.3% vs 24.8%, adjusted risk ratio (aRR) = 1.9; 95% confidence interval (95% CI): 1.4-2.5), compared to newly diagnosed women. This difference was no longer apparent at the time of delivery (aRR 1.2 95% CI: 0.4-3.7). Similarly, viral suppression at delivery was higher among women with pre-pregnancy ART (87.2% vs 69.3%, aRR 1.3, 95% CI: 1.1-1.6) as compared to the newly diagnosed women. Viral suppression rate among newly diagnosed women increased substantially by the time of delivery from 43.5% to 69.3% (p = 0.001).

CONCLUSION

These results show that pre-pregnancy ART improves immunologic and virologic control during pregnancy and call for renewed efforts in HIV testing, linkage to ART and viral monitoring.

摘要

背景

尽管南非的预防母婴传播（PMTCT）项目取得了成功，但生育年龄妇女中仍有 30%的 HIV 感染率，这要求 PMTCT 项目最大程度地提高效率，以维持垂直 HIV 传播预防方面的成果。我们旨在确定在南非豪登省，根据 CD4<500 个细胞/μl 的抗逆转录病毒治疗（ART）资格标准和普遍检测和治疗（UTT）政策受孕的 HIV 阳性妇女在进入产前保健（ANC）时以及分娩时的免疫和病毒学状况。

方法

我们对 2016 年 9 月至 2017 年 12 月期间分娩的 692 名 HIV 阳性成年（>18 岁）产后妇女进行了回顾性队列研究。从同意的妇女的医疗记录中获得了 ANC 开始（分娩前 3-9 个月）和分娩时（分娩前/后 3 个月）的人口统计学，病毒载量（VL）和 CD4 数据。我们比较了在 ANC 开始时和分娩时有孕前 ART、孕期已知 HIV 阳性但孕期有 ART 和孕期新诊断有 ART 的妇女中 CD4≥500 个细胞/μl 和病毒载量（VL）抑制率（<400 个拷贝/ml）。通过对数二项式回归评估了具有高 CD4 和抑制 VL 的预测因素。

结果

在 692 名参与者中，有 394 名（57.0%）有 CD4 数据，有 326 名（47.1%）有 VL 数据。总体而言，与新诊断的妇女相比，有孕前 ART 的妇女更有可能在 ANC 开始时 CD4 计数≥500 个细胞/μl（46.3%对 24.8%，调整风险比（aRR）=1.9；95%置信区间（95%CI）：1.4-2.5）。这种差异在分娩时不再明显（aRR 1.2 95%CI：0.4-3.7）。同样，与新诊断的妇女相比，有孕前 ART 的妇女在分娩时的病毒抑制率更高（87.2%对 69.3%，aRR 1.3，95%CI：1.1-1.6）。新诊断妇女的病毒抑制率在分娩时从 43.5%显著增加到 69.3%（p=0.001）。