南非东开普省母婴抗逆转录病毒疗法启动时机、CD4 计数和 HIV 病毒载量对出生结局的影响：二次数据分析。

Effects of the timing of maternal antiretroviral therapy initiation, CD4 count, and HIV viral load on birth outcomes in the Eastern Cape province of South Africa: A secondary data analysis.

机构信息

Department of Paediatrics, Cecilia Makiwane Hospital, Walter Sisulu University, East London, South Africa.

Department of Infection and Tropical Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, South Yorkshire, United Kingdom.

出版信息

PLoS One. 2024 Sep 6;19(9):e0308374. doi: 10.1371/journal.pone.0308374. eCollection 2024.

DOI:10.1371/journal.pone.0308374

PMID:39240844

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11379262/

Abstract

BACKGROUND

Antiretroviral therapy (ART) use during pregnancy is essential to prevent vertical transmission of HIV, but it may also increase the risk of adverse birth outcomes. This study investigated the impact of both maternal HIV infection and the timing of ART initiation on birth outcomes in women living with HIV in South Africa.

METHODS

This secondary data analysis examined the dataset from an earlier cohort study involving 1709 pregnant women living with HIV who delivered their babies at three major maternity centres in the Eastern Cape province of South Africa between September 2015 and May 2018. The associations between adverse birth outcomes (stillbirth, preterm birth, very preterm birth, and low birth weight) and the timing of maternal ART initiation, peripartum CD4 count, and HIV viral load were examined using logistic regression analysis.

RESULTS

The observed rates of stillbirth, preterm birth, very preterm birth, and low birth weight were 1.4%, 33.5%, 5.4% and 18.0%, respectively. In the multivariable analysis, low birth weight was associated with ART initiated during the second trimester (adjusted odds ratio [aOR] 1.38; 95% confidence interval [CI], 1.03-1.85), low-level viraemia (21-999 copies/ml) (aOR, 1.62; 95% CI, 1.17-2.22), and high-level viraemia (≥1000 copies/ml) (aOR, 1.66; 95% CI, 1.66-2.38) during the peripartum period. Preterm birth was associated with low-level viraemia (aOR, 1.44; 95% CI, 1.16-1.79) and a CD4 count of less than 200 cells/mm3 (aOR, 1.35; 95% CI, 1.01-1.82). Very preterm birth was associated with detectable maternal viraemia.

CONCLUSION

Adverse birth outcomes are common among pregnant women living with HIV, especially those with unsuppressed viraemia. Clinicians and programme managers should prioritise timeous ART initiation and virological suppression in all pregnant women living with HIV.

摘要

背景

抗逆转录病毒疗法（ART）在怀孕期间的使用对于预防艾滋病毒垂直传播至关重要，但也可能增加不良出生结局的风险。本研究调查了南非艾滋病毒感染者中母亲 HIV 感染和开始 ART 的时机对出生结局的影响。

方法

这是对一项早期队列研究数据的二次分析，涉及 1709 名在南非东开普省的三个主要妇产中心分娩的艾滋病毒感染者孕妇，研究时间为 2015 年 9 月至 2018 年 5 月。使用逻辑回归分析检查不良出生结局（死产、早产、极早产和低出生体重）与母亲开始 ART 的时机、围产期 CD4 计数和 HIV 病毒载量之间的关联。

结果

观察到的死产、早产、极早产和低出生体重的发生率分别为 1.4%、33.5%、5.4%和 18.0%。在多变量分析中，低出生体重与妊娠中期开始的 ART（调整后的优势比[aOR] 1.38；95%置信区间[CI]，1.03-1.85）、围产期低水平病毒血症（21-999 拷贝/ml）（aOR，1.62；95%CI，1.17-2.22）和高水平病毒血症（≥1000 拷贝/ml）（aOR，1.66；95%CI，1.66-2.38）相关。早产与低水平病毒血症（aOR，1.44；95%CI，1.16-1.79）和 CD4 计数<200 个细胞/mm3（aOR，1.35；95%CI，1.01-1.82）相关。极早产与可检测到的母体病毒血症有关。