Solthis, Paris, France.
Infectious Diseases, CHU Pitié-Salpêtrière, Paris, France.
J Antimicrob Chemother. 2022 Oct 28;77(11):3093-3101. doi: 10.1093/jac/dkac287.
Nearly half of HIV-infected children worldwide are born in West and Central African countries where access to prevention of mother-to-child transmission of HIV (PMTCT) programmes is still limited. WHO recommends reinforced antiretroviral prophylaxis for infants at high risk of mother-to-child transmission of HIV (MTCT) but its implementation needs further investigation in the field.
The prospective ANRS 12344-DIAVINA study evaluated the feasibility of a strategy combining early infant diagnosis (EID) and reinforced antiretroviral prophylaxis in high-risk infants as identified by interviews with mothers at Ignace Deen Hospital, Conakry, Guinea.
6493 women were admitted for delivery, 6141 (94.6%) accepted HIV testing and 114 (1.9%) were HIV positive. Among these, 51 high-risk women and their 56 infants were included. At birth, a blood sample was collected for infant EID and reinforced antiretroviral prophylaxis was initiated in 48/56 infants (86%, 95% CI 77%-95%). Iron supplementation was given to 35% of infants for non-severe anaemia. Retrospective measurement of maternal plasma viral load (pVL) at delivery revealed that 52% of women had pVL < 400 copies/mL attributable to undisclosed HIV status and/or antiretroviral intake. Undisclosed HIV status was associated with self-stigmatization (85% versus 44%, P = 0.02). Based on the results of maternal pVL at delivery, 'real' high-risk infants were more frequently lost to follow-up (44% versus 8%, P < 0.01) in comparison with low-risk infants, and this was associated with mothers' stigmatization (69% versus 31%, P < 0.01).
Reinforced antiretroviral prophylaxis and EID at birth are widely feasible. However, mothers' self-disclosure of HIV status and antiretroviral intake do not allow adequate evaluation of MTCT risk, which argues for maternal pVL measurement near delivery. Furthermore, actions against stigmatization are crucial to improve PMTCT.
全球近一半的 HIV 感染儿童出生在西非和中非国家，这些国家获得预防母婴传播艾滋病毒（PMTCT）方案的机会仍然有限。世界卫生组织（WHO）建议对有高母婴传播艾滋病毒（MTCT）风险的婴儿强化抗逆转录病毒预防，但在该领域需要进一步调查其实施情况。
前瞻性 ANRS 12344-DIAVINA 研究评估了在几内亚科纳克里 Ignace Deen 医院通过对母亲进行访谈确定的高危婴儿中，联合早期婴儿诊断（EID）和强化抗逆转录病毒预防的策略的可行性。
6493 名妇女入院分娩，6141 名（94.6%）接受了 HIV 检测，114 名（1.9%）HIV 阳性。其中，有 51 名高危妇女及其 56 名婴儿入选。在出生时，采集婴儿的血液样本进行 EID，并在 48/56 名婴儿（86%，95%CI 77%-95%）中开始强化抗逆转录病毒预防。35%的婴儿因非严重贫血而接受铁补充剂治疗。回顾性测量产妇分娩时的血浆病毒载量（pVL）显示，52%的妇女的 pVL＜400 拷贝/ml，原因是未披露的 HIV 状况和/或抗逆转录病毒药物的摄入。未披露的 HIV 状况与自我污名化有关（85%对 44%，P=0.02）。基于产妇分娩时的 pVL 结果，与低危婴儿相比，“真正”高危婴儿更频繁地失访（44%对 8%，P＜0.01），这与母亲的污名化有关（69%对 31%，P＜0.01）。
强化抗逆转录病毒预防和出生时的 EID 广泛可行。然而，母亲对 HIV 状况和抗逆转录病毒药物摄入的自我披露并不能充分评估 MTCT 风险，这需要在分娩前测量产妇的 pVL。此外，采取行动消除污名化对于改善 PMTCT 至关重要。
