Paioni Paolo, Aebi-Popp Karoline, Martinez de Tejada Begoña, Rudin Christoph, Bernasconi Enos, Braun Dominique L, Kouyos Roger, Wagner Noémie, Crisinel Pierre Alex, Güsewell Sabine, Darling Katharine E A, Duppenthaler Andrea, Baumann Marc, Polli Christian, Fischer Tina, Kahlert Christian R
Division of Infectious Diseases and Hospital Epidemiology, University Children's Hospital Zurich, Zurich, Switzerland.
Department of Infectious Diseases, Bern University Hospital, University of Bern, Switzerland.
Lancet Reg Health Eur. 2023 Jun 1;31:100656. doi: 10.1016/j.lanepe.2023.100656. eCollection 2023 Aug.
Low rates of postnatal retention in HIV care and viral suppression have been reported in women living with HIV (WLWH) despite viral suppression at delivery. At the same time, postpartum follow-up is of crucial importance in light of the increasing support offered in many resource-rich countries including Switzerland to WLWH choosing to breastfeed their infant, if optimal scenario criteria are met.
We longitudinally investigated retention in HIV care, viral suppression, and infant follow-up in a prospective multicentre HIV cohort study of WLWH in the optimal scenario who had a live birth between January 2000 and December 2018. Risk factors for adverse outcomes in the first year postpartum were assessed using logistic and proportional hazard models.
Overall, WLWH were retained in HIV care for at least six months after 94.2% of the deliveries (694/737). Late start of combination antiretroviral therapy (cART) during the third trimester was found to be the main risk factor for failure of retention in HIV care (crude odds ratio [OR] 3.91; 95% confidence interval [CI], 1.50-10.22; p = 0.005). Among mothers on cART until at least one year after delivery, 4.4% (26/591) experienced viral failure, with illicit drugs use being the most important risk factor (hazard ratio [HR], 13.2; 95% CI, 2.35-73.6; p = 0.003). The main risk factors for not following the recommendations regarding infant follow-up was maternal depression (OR, 3.52; 95% CI, 1.18-10.52; p = 0.024).
Although the results are reassuring, several modifiable risk factors for adverse postpartum outcome, such as late treatment initiation and depression, were identified. These factors should be addressed in HIV care of all WLWH, especially those opting to breastfeed in resource-rich countries.
This study has been financed within the framework of the Swiss HIV Cohort Study, supported by the Swiss National Science Foundation (grant #201369), by SHCS project 850 and by the SHCS research foundation.
尽管分娩时病毒得到抑制，但据报道，感染艾滋病毒的女性（WLWH）产后保留在艾滋病毒护理中的比例较低，病毒抑制率也较低。与此同时，鉴于包括瑞士在内的许多资源丰富的国家为选择母乳喂养婴儿的感染艾滋病毒的女性提供了越来越多的支持，产后随访至关重要，前提是符合最佳情况标准。
我们在一项针对2000年1月至2018年12月期间有活产的处于最佳情况的感染艾滋病毒的女性的前瞻性多中心艾滋病毒队列研究中，纵向调查了她们在艾滋病毒护理中的保留情况、病毒抑制情况和婴儿随访情况。使用逻辑回归和比例风险模型评估产后第一年不良结局的风险因素。
总体而言，94.2%（694/737）的分娩后，感染艾滋病毒的女性在艾滋病毒护理中保留至少六个月。发现孕晚期开始联合抗逆转录病毒疗法（cART）是艾滋病毒护理保留失败的主要风险因素（粗比值比[OR]3.91；95%置信区间[CI]，1.50-10.22；p = 0.005）。在分娩后至少一年接受cART治疗的母亲中，4.4%（26/591）出现病毒学失败，使用非法药物是最重要的风险因素（风险比[HR]，13.2；95%CI，2.35-73.6；p = 0.003）。不遵循婴儿随访建议的主要风险因素是母亲抑郁（OR，3.52；95%CI，1.18-10.52；p = 0.024）。
尽管结果令人放心，但确定了一些可改变的产后不良结局风险因素，如治疗开始延迟和抑郁。在所有感染艾滋病毒的女性的艾滋病毒护理中，应解决这些因素，特别是那些在资源丰富的国家选择母乳喂养的女性。
本研究是在瑞士艾滋病毒队列研究的框架内资助的，得到了瑞士国家科学基金会（资助编号#201369）、SHCS项目850和SHCS研究基金会的支持。
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