Moyo F, Mazanderani A H, Kufa T, Sherman G G
Centre for HIV and STIs, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Paediatric HIV Diagnostics Division, Wits Health Consortium, Johannesburg, South Africa.
S Afr Med J. 2021 Apr 30;111(5):469-473. doi: 10.7196/SAMJ.2021.v111i5.15240.
Pregnant and breastfeeding women living with HIV (WLHIV) are a target population for elimination of mother-to-child transmission of HIV (eMTCT). However, there are limited data on maternal virological responses during pregnancy and the postpartum period in South Africa (SA).
To review compliance of viral load (VL) testing with national guidelines and suppression rates during pregnancy and up to 9 months postpartum among WLHIV delivering in four tertiary hospitals in Gauteng Province, SA.
All women who had a point-of-care HIV VL test using Xpert HIV-1 VL (Cepheid, USA) at delivery in four tertiary obstetric units in Gauteng between June 2018 and February 2020 were included. HIV VL tests of eligible women performed up to 9 months before and after delivery were extracted from the National Health Laboratory Service's Corporate Data Warehouse. Proportions of women delivering who had antenatal and postpartum VL tests performed and their suppression rates were determined and expressed as percentages.
Of 4 989 eligible WLHIV (median age 31.1 years), 917 (18.4%) had a VL performed during the antenatal period; of these, 335 (36.5%) had a VL ≥50 copies/mL and 165 (18.0%) a VL ≥1 000 copies/mL. At delivery, 1 911 women (38.3%) had a VL ≥50 copies/mL and 1 028 (20.6%) a VL ≥1 000 copies/mL. Among 627 women (12.6%) with a VL test postpartum, 234 (37.3%) had a VL ≥50 copies/mL and 93 (14.8%) a VL ≥1 000 copies/mL. Overall, having a VL test performed during the antenatal period was associated with viral suppression at delivery and receiving a VL test postpartum (p<0.001). Women with a VL ≥50 copies/mL at delivery were more likely to be younger and to remain virally unsuppressed postpartum (p<0.001) compared with women with a VL <50 copies/mL.
Fewer than 5% of WLHIV with a VL at the time of delivery received VL monitoring during the antenatal and postpartum periods in accordance with national guidelines. More than 80% of WLHIV delivering had no evidence of VL monitoring during the antenatal period, and they were more likely than women who received monitoring during the antenatal period to be virally unsuppressed at delivery and to receive no VL monitoring postpartum. Women with a high VL at delivery were likely to remain virally unsuppressed postpartum. These results emphasise the need for closer monitoring of and rapid reaction to high maternal VLs during pregnancy, at delivery and postpartum for attainment of eMTCT.
感染艾滋病毒的孕妇和哺乳期妇女（WLHIV）是消除母婴传播艾滋病毒（eMTCT）的目标人群。然而，关于南非（SA）孕期和产后母亲病毒学反应的数据有限。
回顾豪登省四所三级医院中分娩的WLHIV在孕期及产后9个月内病毒载量（VL）检测的指南依从性和病毒抑制率。
纳入2018年6月至2020年2月在豪登省四个三级产科单位分娩时使用Xpert HIV-1 VL（美国赛沛公司）进行即时检测的所有妇女。从国家卫生实验室服务公司的数据仓库中提取符合条件的妇女在分娩前和分娩后9个月内进行的HIV VL检测结果。确定进行产前和产后VL检测的分娩妇女比例及其抑制率，并以百分比表示。
在4989名符合条件的WLHIV中（中位年龄31.1岁），917名（18.4%）在孕期进行了VL检测；其中，335名（36.5%）的VL≥50拷贝/毫升，165名（18.0%）的VL≥1000拷贝/毫升。分娩时，1911名妇女（38.3%）的VL≥50拷贝/毫升，1028名（20.6%）的VL≥1000拷贝/毫升。在627名产后进行VL检测的妇女中（12.6%），234名（37.3%）的VL≥50拷贝/毫升，93名（14.8%）的VL≥1000拷贝/毫升。总体而言，孕期进行VL检测与分娩时病毒抑制及产后接受VL检测相关（p<0.001）。与VL<50拷贝/毫升的妇女相比，分娩时VL≥50拷贝/毫升的妇女更年轻，产后病毒更不易被抑制（p<0.001）。
分娩时进行VL检测的WLHIV中，按照国家指南在产前和产后接受VL监测的不到5%。超过80%的分娩WLHIV在孕期没有VL监测证据，与孕期接受监测的妇女相比，她们在分娩时病毒更不易被抑制，产后也未接受VL监测。分娩时VL高的妇女产后病毒可能仍不易被抑制。这些结果强调了在孕期、分娩时和产后密切监测并对高母亲VL迅速做出反应以实现eMTCT的必要性。
