撒哈拉以南非洲地区孕妇和哺乳期妇女中的艾滋病毒感染事件：系统评价和荟萃分析。
Incident HIV among pregnant and breast-feeding women in sub-Saharan Africa: a systematic review and meta-analysis.
机构信息
Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, USA.
UNC Global Projects - Zambia, Lusaka, Zambia.
出版信息
AIDS. 2020 Apr 1;34(5):761-776. doi: 10.1097/QAD.0000000000002487.
OBJECTIVES
A previous meta-analysis reported high HIV incidence among pregnant and breast-feeding women in sub-Saharan Africa (SSA), but limited evidence of elevated risk of HIV acquisition during pregnancy or breast-feeding when compared with nonpregnant periods. The rapidly evolving HIV prevention and treatment landscape since publication of this review may have important implications for maternal HIV incidence.
DESIGN
Systematic review and meta-analysis.
METHODS
We searched four databases and abstracts from relevant conferences through 1 December 2018, for literature on maternal HIV incidence in SSA. We used random-effects meta-analysis to summarize incidence rates and ratios, and to estimate 95% prediction intervals. We evaluated potential sources of heterogeneity with random-effects meta-regression.
RESULTS
Thirty-seven publications contributed 100 758 person-years of follow-up. The estimated average HIV incidence rate among pregnant and breast-feeding women was 3.6 per 100 person-years (95% prediction interval: 1.2--11.1), while the estimated average associations between pregnancy and risk of HIV acquisition, and breast-feeding and risk of HIV acquisition, were close to the null. Wide 95% prediction intervals around summary estimates highlighted the variability of HIV incidence across populations of pregnant and breast-feeding women in SSA. Average HIV incidence appeared associated with age, partner HIV status, and calendar time. Average incidence was highest among studies conducted pre-2010 (4.1/100 person-years, 95% prediction interval: 1.1--12.2) and lowest among studies conducted post-2014 (2.1/100 person-years, 95% prediction interval: 0.7--6.5).
CONCLUSION
Substantial HIV incidence among pregnant and breast-feeding women in SSA, even in the current era of combination HIV prevention and treatment, underscores the need for prevention tailored to high-risk pregnant and breast-feeding women.
目的
先前的荟萃分析报告称，撒哈拉以南非洲（SSA）的孕妇和哺乳期妇女的 HIV 发病率较高，但与非怀孕期相比，怀孕期间或哺乳期 HIV 感染风险增加的证据有限。自该综述发表以来，HIV 预防和治疗领域的迅速发展可能对孕产妇 HIV 发病率产生重要影响。
设计
系统评价和荟萃分析。
方法
我们通过 2018 年 12 月 1 日，在四个数据库和相关会议的摘要中搜索了 SSA 孕产妇 HIV 发病率的文献。我们使用随机效应荟萃分析总结发病率和比值，并估计 95%预测区间。我们使用随机效应荟萃回归评估潜在的异质性来源。
结果
37 篇文献提供了 100758 人年的随访数据。估计孕妇和哺乳期妇女的平均 HIV 发病率为 3.6/100 人年（95%预测区间：1.2-11.1），而怀孕与 HIV 感染风险之间的平均关联，以及母乳喂养与 HIV 感染风险之间的平均关联，接近于零。汇总估计值的宽 95%预测区间突出了 SSA 孕妇和哺乳期妇女群体中 HIV 发病率的变异性。平均 HIV 发病率似乎与年龄、伴侣 HIV 状况和日历时间有关。平均发病率与 2010 年之前进行的研究（4.1/100 人年，95%预测区间：1.1-12.2）最高，与 2014 年之后进行的研究（2.1/100 人年，95%预测区间：0.7-6.5）最低。
结论
即使在当前联合 HIV 预防和治疗的时代，撒哈拉以南非洲的孕妇和哺乳期妇女中 HIV 发病率仍然很高，这突显了需要针对高风险孕妇和哺乳期妇女制定预防措施。
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