HIV-1 母婴传播和儿科人群中病毒储存库特征：对喀麦隆研究的系统评价和荟萃分析。

The mother-to-child transmission of HIV-1 and profile of viral reservoirs in pediatric population: A systematic review with meta-analysis of the Cameroonian studies.

机构信息

Chantal Biya International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB), Yaounde, Cameroon.

University of Rome "Tor Vergata" (UTV-Rome), Rome, Italy.

出版信息

PLoS One. 2023 Jan 17;18(1):e0278670. doi: 10.1371/journal.pone.0278670. eCollection 2023.

DOI:10.1371/journal.pone.0278670

PMID:36649370

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9844886/

Abstract

BACKGROUND

The mother-to-child transmission of HIV-1 (MTCT) remains on the major route of HIV-transmission among pediatric populations in Africa. Though a prevention of MTCT (PMTCT) high-priority country, data on the MTCT burdens in Cameroon remains fragmented.

OBJECTIVE

We sought to assess the pooled MTCT rate, its risk-factors, and to characterize viral reservoirs of infected-children in Cameroon.

METHODS

All relevant observational cohort and cross-sectional studies conducted in Cameroon were searched from PubMed, African Journals Online, Google scholar, ScienceDirect and academic medical education databases. Heterogeneity and publication bias were respectively assessed by the I2 statistic and the Egger/funnel plot test. Meta-analysis was performed using the random effects model. MTCT rate >5% was considered as "high". This review was registered in the Prospero database, CRD42021224497.

RESULTS

We included a total of 29 studies and analyzed 46 684 children born from HIV-positive mothers. The overall rate of MTCT was 7.00% (95% CI = 6.07-8.51). According to regions, the highest burden was in Adamaoua-region (17.51% [95% CI:14.21-21.07]) with only one study found. PMTCT option-B+ resulted in about 25% reduction of MTCT (8.97% [95% CI: 8.71-9.24] without option-B+ versus 2.88% [95% CI: 5.03-9.34] with option-B+). Regarding risk-factors, MTCT was significantly associated with the absence of PMTCT-interventions both in children (OR:5.40 [95% CI: 2.58-11.27]) and mothers (OR: 3.59 [95% CI: 2.15-5.99]). Regarding viral reservoirs, a pro-viral DNA mean of 3.34±1.05 log10/mL was observed among 5/57 children and archived HIV drug resistance mutations were identified in pro-viral DNA marker among 21/79 infected-children.

CONCLUSION

In spite of the dropdown in MTCT following option-B+ implementation, MTCT remains high in Cameroon, with substantial disparities across regions. Thus, in this era of option-B+, achieving MTCT elimination requires interventions in northern-Cameroon. The variation in pro-viral load in infected-children underlines the relevance of characterizing viral reservoirs for possible infection control in tropical settings.

摘要

背景

在非洲，母婴传播（MTCT）仍然是儿科人群中 HIV 传播的主要途径。尽管喀麦隆是预防母婴传播（PMTCT）的重点国家，但有关该国有 MTCT 负担的数据仍然零散。

目的

我们旨在评估喀麦隆的 MTCT 率、其危险因素，并描述感染儿童的病毒库特征。

方法

从 PubMed、非洲在线期刊、Google Scholar、ScienceDirect 和学术医学教育数据库中搜索了在喀麦隆进行的所有相关观察性队列研究和横断面研究。分别使用 I2 统计量和 Egger/漏斗图检验评估异质性和发表偏倚。使用随机效应模型进行荟萃分析。MTCT 率>5%被认为是“高”。本综述在 Prospero 数据库中注册，CRD42021224497。

结果

我们共纳入 29 项研究，分析了 46684 名来自 HIV 阳性母亲的儿童。总体 MTCT 率为 7.00%（95%CI=6.07-8.51）。按地区划分，最高负担在阿达马瓦地区（17.51%[95%CI：14.21-21.07]），仅发现一项研究。PMTCT 选项 B+可使 MTCT 降低约 25%（无选项 B+时为 8.97%[95%CI：8.71-9.24]，有选项 B+时为 2.88%[95%CI：5.03-9.34]）。关于危险因素，在儿童（OR：5.40[95%CI：2.58-11.27]）和母亲（OR：3.59[95%CI：2.15-5.99]）中，MTCT 均与缺乏 PMTCT 干预显著相关。关于病毒库，在 5/57 名儿童中观察到前病毒 DNA 的平均中位值为 3.34±1.05log10/mL，在 21/79 名感染儿童的前病毒 DNA 标志物中发现了存档的 HIV 耐药突变。