Mkandawire Felix A, Buchwald Andrea, Nampota-Nkomba Nginache, Nyirenda Osward M, Zuze Kingsley, Kuria Shiphrah, Cairo Cristiana, Laufer Miriam K
Blantyre Malaria Project, Kamuzu University of Health Sciences, College of Medicine, Blantyre, Malawi.
Amref International University, Nairobi, Kenya.
AIDS Care. 2024 Jan 7:1-8. doi: 10.1080/09540121.2023.2298792.
We evaluated detectable viral load (VL) in pregnant women established on antiretroviral therapy (ART) for at least 6 months before conception and those self-reported as ART naïve at first antenatal care (ANC) at two government clinics in Southern Malawi. We used logistic regression to identify the predictors of detectable viral load (VL), defined as any measure greater than 400 copies/ml. Of 816 women, 67.9% were established on ART and 32.1% self-reported as ART naïve. Among women established on ART, 10.8% had detectable VL and 9.9% had VL >1000 copies/ml (WHO criteria for virological failure). In adjusted analysis, among women established on ART, virological failure was associated with younger age ( = .02), "being single/widowed" ( = 0.001) and no previous deliveries ( = .05). One fifth of women who reported to be ART-naive were found to have an undetectable VL at first ANC. None of the demographic factors could significantly differentiate those with high versus low VL in the ART-naïve sub-sample. In this cohort, approximately 90% of women who had initiated ART prior to conception had an undetectable VL at first ANC. This demonstrates good success of the ART program but identifies high risk populations that require additional support.
我们在马拉维南部的两家政府诊所，对在受孕前至少接受了6个月抗逆转录病毒治疗（ART）的孕妇以及在首次产前检查（ANC）时自我报告未接受过ART治疗的孕妇的可检测病毒载量（VL）进行了评估。我们使用逻辑回归来确定可检测病毒载量（VL）的预测因素，可检测病毒载量定义为任何大于400拷贝/毫升的测量值。在816名女性中，67.9%接受了ART治疗，32.1%自我报告未接受过ART治疗。在接受ART治疗的女性中，10.8%的病毒载量可检测到，9.9%的病毒载量>1000拷贝/毫升（世界卫生组织的病毒学失败标准）。在调整分析中，在接受ART治疗的女性中，病毒学失败与年龄较小（P = 0.02）、“单身/丧偶”（P = 0.001）以及既往未分娩（P = 0.05）有关。在首次产前检查时，五分之一自我报告未接受过ART治疗的女性被发现病毒载量不可检测。在未接受过ART治疗的子样本中，没有任何人口统计学因素能够显著区分病毒载量高与低的人群。在这个队列中，大约90%在受孕前开始接受ART治疗的女性在首次产前检查时病毒载量不可检测。这证明了ART项目取得了良好的成效，但也确定了需要额外支持的高风险人群。
