Elizabeth Glaser Pediatric AIDS Foundation, Maseru, Lesotho.
Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC, USA.
J Int AIDS Soc. 2020 Dec;23(12):e25648. doi: 10.1002/jia2.25648.
Following the implementation of the provision of lifelong antiretroviral therapy to all HIV-positive pregnant or breastfeeding women for prevention of mother-to-child transmission (PMTCT) of HIV by the Kingdom of Lesotho in 2013, we assessed the effectiveness of this approach by evaluating 24-month HIV-free survival among HIV-exposed infants (HEIs).
We conducted a prospective observational cohort study that enrolled HIV-positive and HIV-negative pregnant women, with follow-up of women and their infants for 24 months after delivery. Participant recruitment started in June 2014 and follow-up ended in September 2018. Trained nurses collected study information through patient interviews and chart abstraction at enrolment and every three to six months thereafter. Maternal HIV testing, infant mortality, HIV transmission and HIV-free survival rates were computed using Kaplan-Meier estimation. Cox regression hazard models were used to identify factors associated with infant HIV infection and death.
Between June 2014 and February 2016, we enrolled 653 HIV-positive and 941 HIV-negative pregnant women. Twenty-seven HIV-negative women acquired HIV during follow-up. Ultimately, 634 liveborn HEI (382 (52%) male, 303 (48%) female, 3 missing) and 839 who remained HIV-unexposed (HUIs) (409 (49.0%) male, 426 (51.0%) female, 4 missing) were followed; 550 HEIs and 701 HUIs completed the 24-month follow-up period. Of 607 (95.7%) HEIs who were tested for HIV at least once during follow-up, 17 were found to be HIV-positive. Two (9.5%) of 21 infants born to mothers who acquired HIV infection during follow-up were HIV-positive compared to 15 (2.4%) of 613 HEI born to women with known HIV infection. The risk of HIV transmission from HIV-positive mothers to their infants by 24 months of age was 2.9% (95% CI: 1.8 to 4.7). The estimated 24-month mortality rate among HEIs was 6.0% (95% CI: 4.4 to 8.2) compared to 3.8% (95% CI: 2.6 to 5.3) among HUIs (Log-rank p = 0.065). HIV-free survival at 24 months was 91.8% (95% CI: 89.2 to 93.7). Lower maternal age and birth weight were independently associated with increased HIV infection or death of infants.
The implementation of lifelong ART for PMTCT in the Lesotho public health system resulted in low HIV transmission, but survival of HEI remains lower than their HIV uninfected counterparts.
2013 年，莱索托王国实施了为所有 HIV 阳性孕妇或哺乳期妇女终生提供抗逆转录病毒治疗以预防母婴传播（PMTCT）的规定，我们通过评估 HIV 暴露婴儿（HEI）的 24 个月无 HIV 生存情况，评估了这一方法的有效性。
我们进行了一项前瞻性观察队列研究，纳入了 HIV 阳性和 HIV 阴性孕妇，在分娩后对妇女及其婴儿进行 24 个月的随访。参与者招募工作于 2014 年 6 月开始，随访于 2018 年 9 月结束。经过培训的护士通过患者访谈和图表摘录在入组时以及此后每 3 至 6 个月收集研究信息。使用 Kaplan-Meier 估计法计算母婴 HIV 检测、婴儿死亡率、HIV 传播和 HIV 无生存生存率。使用 Cox 回归风险模型确定与婴儿 HIV 感染和死亡相关的因素。
2014 年 6 月至 2016 年 2 月期间，我们共纳入了 653 名 HIV 阳性和 941 名 HIV 阴性孕妇。27 名 HIV 阴性孕妇在随访期间感染了 HIV。最终，我们随访了 634 名活产 HEI（382 名（52%）男婴，303 名（48%）女婴，3 名失踪）和 839 名仍未暴露于 HIV 的婴儿（HUIs）（409 名（49.0%）男婴，426 名（51.0%）女婴，4 名失踪）；550 名 HEI 和 701 名 HUIs 完成了 24 个月的随访期。在至少接受过一次 HIV 检测的 607 名（95.7%）HEI 中，发现有 17 名 HIV 阳性。在 21 名在随访期间感染 HIV 的母亲所生的婴儿中，有 2 名（9.5%）为 HIV 阳性，而在 613 名已知感染 HIV 的母亲所生的 613 名 HEI 中，有 15 名（2.4%）为 HIV 阳性。在 24 个月时，HIV 阳性母亲将 HIV 传播给婴儿的风险为 2.9%（95%CI：1.8 至 4.7）。HEI 的 24 个月死亡率为 6.0%（95%CI：4.4 至 8.2），而 HUIs 的死亡率为 3.8%（95%CI：2.6 至 5.3）（对数秩检验 p=0.065）。24 个月的 HIV 无生存生存率为 91.8%（95%CI：89.2 至 93.7）。母亲年龄较小和出生体重较低与婴儿 HIV 感染或死亡的风险增加独立相关。
莱索托公共卫生系统实施终生抗逆转录病毒治疗以预防母婴传播，结果导致 HIV 传播率较低，但 HEI 的生存率仍低于未感染 HIV 的婴儿。
