Short Charlotte-Eve S, Byrne Laura, Hagan-Bezgin Aishah, Quinlan Rachael A, Anderson Jane, Brook Gary, De Alwis Okavas, de Ruiter Annemiek, Farrugia Pippa, Fidler Sarah, Hamlyn Eleanor, Hartley Anna, Murphy Siobhan, Noble Heather, Oomeer Soonita, Roedling Sherie, Rosenvinge Melanie, Rubinstein Luciana, Shah Rimi, Singh Selena, Thorne Elizabeth, Toby Martina, Wait Brenton, Sarner Liat, Taylor Graham P
Department of Infectious Disease, Imperial College London, London W2 1PG, UK.
Imperial College NIHR BRC, Imperial College London, London W2 1NY, UK.
Pathogens. 2024 Apr 10;13(4):308. doi: 10.3390/pathogens13040308.
(1) Background: The evidence base for the management of spontaneous viral controllers in pregnancy is lacking. We describe the management outcomes of pregnancies in a series of UK women with spontaneous HIV viral control (<100 copies/mL 2 occasions before or after pregnancy off ART). (2) Methods: A multi-centre, retrospective case series (1999-2021) comparing pre- and post-2012 when guidelines departed from zidovudine-monotherapy (ZDVm) as a first-line option. Demographic, virologic, obstetric and neonatal information were anonymised, collated and analysed in SPSS. (3) Results: A total of 49 live births were recorded in 29 women, 35 pre-2012 and 14 post. HIV infection was more commonly diagnosed in first reported pregnancy pre-2012 (15/35) compared to post (2/14), = 0.10. Pre-2012 pregnancies were predominantly managed with ZDVm (28/35) with pre-labour caesarean section (PLCS) (24/35). Post-2012 4/14 received ZDVm and 10/14 triple ART, = 0.002. Post-2012 mode of delivery was varied (5 vaginal, 6 PLCS and 3 emergency CS). No intrapartum ZDV infusions were given post-2012 compared to 11/35 deliveries pre-2012. During pregnancy, HIV was detected (> 50 copies/mL) in 14/49 pregnancies (29%) (median 92, range 51-6084). Neonatal ZDV post-exposure prophylaxis was recorded for 45/49 infants. No transmissions were reported. (4) Conclusion: UK practice has been influenced by the change in guidelines, but this has had little impact on CS rates.
(1) 背景：缺乏关于孕期自发病毒控制者管理的循证依据。我们描述了一系列英国自发实现HIV病毒控制（孕期前后两次未接受抗逆转录病毒治疗时病毒载量<100拷贝/毫升）女性的妊娠管理结果。(2) 方法：一项多中心回顾性病例系列研究（1999 - 2021年），比较2012年前后的情况，2012年指南不再将齐多夫定单药治疗（ZDVm）作为一线选择。对人口统计学、病毒学、产科和新生儿信息进行匿名处理，在SPSS中进行整理和分析。(3) 结果：29名女性共记录到49例活产，2012年前35例，2012年后14例。与2012年后（2/14）相比，2012年前首次报告妊娠时更常诊断出HIV感染（15/35），P = 0.10。2012年前的妊娠主要采用ZDVm治疗（28/35）并进行临产前剖宫产（PLCS）（24/35）。2012年后，14例中有4例接受ZDVm治疗，10例接受三联抗逆转录病毒治疗，P = 0.002。2012年后的分娩方式多样（5例阴道分娩、6例PLCS和3例急诊剖宫产）。与2012年前35例分娩中有11例相比，2012年后未进行产时ZDV输注。孕期，49例妊娠中有14例（29%）检测到HIV（>50拷贝/毫升）（中位数92，范围51 - 6084）。49例婴儿中有45例记录了新生儿暴露后ZDV预防。未报告有传播情况。(4) 结论：英国的实践受到指南变化的影响，但这对剖宫产率影响不大。
