基于多替拉韦的一线抗逆转录病毒疗法对埃塞俄比亚HIV暴露婴儿中HIV母婴传播的影响：一项前后对照研究。
Effect of Dolutegravir-Based First-Line Antiretroviral Therapy on Mother-to-Child Transmission of HIV Among HIV-Exposed Infants in Ethiopia: a Before-and-After Study.
作者信息
Facha Wolde, Tadesse Takele, Wolka Eskinder, Astatkie Ayalew
机构信息
Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia.
School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia.
出版信息
HIV AIDS (Auckl). 2024 May 13;16:203-215. doi: 10.2147/HIV.S456261. eCollection 2024.
BACKGROUND
Currently, Dolutegravir (DTG)-based regimens are administered to women on Option B plus to prevent mother-to-child transmission (MTCT) of the virus. However, its effect on reducing MTCT of human immunodeficiency virus (HIV) among HIV-exposed infants over the previously used Efavirenz (EFV)-based regimen is unknown.
OBJECTIVE
This study aimed to compare the effects of DTG-based and EFV-based regimens on the MTCT of HIV among HIV-exposed infants in Ethiopia.
METHODS
An uncontrolled before-and-after study design was conducted among 958 mother-infant pairs (479 on EFV-based and 479 on DTG-based regimens) enrolled in the prevention of mother-to-child transmission (PMTCT) care from September 2015 to February 2023. The outcome variable was the HIV infection status among the exposed infants. A log-binomial model was employed, and the proportion was computed to compare the incidence of MTCT of HIV in both groups. The risk ratio (RR) with a 95% confidence interval (CI) was calculated to assess the predictor variables.
RESULTS
Mothers on DTG-based regimens were approximately 44% (adjusted risk ratio (aRR): 0.56; 95% CI: 0.44, 0.70) less likely to transmit HIV to their infants than those on EFV-based regimens. In addition, poor or fair adherence to antiretroviral therapy (ART) (aRR: 5.82; 95% CI: 3.41, 9.93), home delivery (aRR: 3.61; 95% CI: 2.32, 5.62), mixed feeding practice (aRR: 1.83; 95% CI: 1.45, 2.3) and not receiving antiretroviral prophylaxis (aRR: 3.26; 95% CI: 1.6, 6.64) were found to increase the risk of MTCT of HIV infection, whereas older maternal age (aRR: 0.93; 95% CI: 0.9, 0.96) was a protective factor.
CONCLUSION
Mother-to-child transmission of HIV was less frequently observed in mother-infant pairs exposed to the DTG-based regimens as compared to those exposed to the EFV-based regimens. Thus, DTG-based first-line ART regimens supplementation should be sustained to achieve global and national targets for zero new infections in HIV-exposed infants.
背景
目前，基于多替拉韦（DTG）的治疗方案被应用于采用B方案加药的女性，以预防病毒的母婴传播（MTCT）。然而，与先前使用的基于依非韦伦（EFV）的治疗方案相比，其在降低HIV暴露婴儿中HIV母婴传播方面的效果尚不清楚。
目的
本研究旨在比较基于DTG和基于EFV的治疗方案对埃塞俄比亚HIV暴露婴儿中HIV母婴传播的影响。
方法
在2015年9月至2023年2月期间参与预防母婴传播（PMTCT）护理的958对母婴（479对采用基于EFV的治疗方案，479对采用基于DTG的治疗方案）中进行了一项非对照前后研究设计。结局变量是暴露婴儿中的HIV感染状况。采用对数二项模型，并计算比例以比较两组中HIV母婴传播的发生率。计算风险比（RR）及其95%置信区间（CI）以评估预测变量。
结果
与采用基于EFV治疗方案的母亲相比，采用基于DTG治疗方案的母亲将HIV传播给婴儿的可能性大约低44%（调整后风险比（aRR）：0.56；95%CI：0.44，0.70）。此外，对抗逆转录病毒疗法（ART）依从性差或一般（aRR：5.82；95%CI：3.41，9.93）、在家分娩（aRR：3.61；95%CI：2.32，5.62）、混合喂养方式（aRR：1.83；95%CI：1.45，2.3）以及未接受抗逆转录病毒预防（aRR：3.26；95%CI：1.6，6.64）被发现会增加HIV感染母婴传播的风险，而母亲年龄较大（aRR：0.93；95%CI：0.9，0.96）是一个保护因素。
结论
与暴露于基于EFV治疗方案的母婴对相比，暴露于基于DTG治疗方案的母婴对中HIV母婴传播的情况较少见。因此，应持续补充基于DTG的一线抗逆转录病毒治疗方案，以实现全球和国家关于HIV暴露婴儿零新增感染的目标。
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