Centre for HIV & STIs, National Institute for Communicable Diseases, National Health Laboratory Service.
School of Public Health, Faculty of Health Sciences, University of the Witwatersrand.
AIDS. 2021 Feb 2;35(2):307-316. doi: 10.1097/QAD.0000000000002733.
To describe changes in maternal viral control over time in South African women living with HIV (WLHIV) using surveillance data from the National Health Laboratory Service's Corporate Data Warehouse (NHLS CDW).
A retrospective cohort analysis of maternal viral load during pregnancy and up to 15 months postpartum was performed amongst WLHIV (15-49 years) within the public-health sector between 2016 and 2017.
HIV and pregnancy-related test data were used to create a synthetic cohort of pregnant WLHIV from the NHLS CDW. Syphilis-screening, in association with ward type and/or postpregnancy cervical screening and/or birth HIV test and/or positive β-hCG, was used as a proxy for pregnancy. The syphilis-screening date marked the first antenatal care visit (fANC). Fractional polynomial models described viral load evolution from fANC up to 15 months postdelivery. Piecewise linear regression models determined factors associated with viral load decline.
Among 178 319 pregnant WLHIV, 345 174 viral load tests were performed [median = 2 (IQR: 2-3) per woman]. At fANC, 85 545 (48%) women were antiretroviral therapy (ART) experienced; 88 877 (49.8%) were not and 3897 (2.2%) unknown. Proportions of viraemia (viral load ≥50 copies/ml) were 39 756 (53.6%) at first viral load performed during pregnancy, 14 780 (36.9%) at delivery and 24 328 (33.5%) postpartum. Maternal age at least 25 years, CD4+ cell count at least 500 cells/μl and viral load less than 50 copies/ml at baseline predicted sustained viral load suppression during follow-up.
Despite high-ART coverage among pregnant women in South Africa, only 63% of WLHIV achieved viral load less than 50 copies/ml at delivery. Maternal viral load monitoring requires prioritization for maternal health and eMTCT.
利用国家卫生实验室服务公司数据仓库（NHLS CDW）的监测数据，描述南非艾滋病毒感染者（HIV）妇女的母婴病毒控制随时间的变化。
对 2016 年至 2017 年期间公共卫生部门的 15-49 岁 HIV 感染者（HIV）进行了一项回顾性队列分析，评估其孕期及产后 15 个月的病毒载量。
从 NHLS CDW 中使用 HIV 和妊娠相关检测数据创建了一个 HIV 感染者孕妇的合成队列。用梅毒筛查与病房类型和/或产后宫颈筛查和/或出生时 HIV 检测和/或阳性β-hCG 相结合，作为妊娠的替代指标。梅毒筛查日期标记为第一次产前护理就诊（fANC）。分数多项式模型描述了从 fANC 到产后 15 个月的病毒载量演变。分段线性回归模型确定了与病毒载量下降相关的因素。
在 178319 名孕妇 HIV 感染者中，进行了 345174 次病毒载量检测[中位数为每位妇女 2（IQR：2-3）次]。在 fANC 时，85545（48%）名妇女有抗逆转录病毒治疗（ART）经验；88877（49.8%）名妇女无 ART 经验，3897（2.2%）名妇女经验未知。首次孕期进行的病毒载量检测中，病毒血症（病毒载量≥50 拷贝/ml）比例为 39756（53.6%），分娩时为 14780（36.9%），产后为 24328（33.5%）。产妇年龄至少 25 岁、CD4+细胞计数至少 500 个/μl 和基线时病毒载量<50 拷贝/ml 预测了随访期间持续的病毒载量抑制。
尽管南非孕妇接受抗逆转录病毒治疗的比例较高，但只有 63%的 HIV 感染者在分娩时病毒载量<50 拷贝/ml。母婴病毒载量监测需要优先考虑母婴健康和母婴垂直传播阻断。
