Castillo-Rozas Gabriel, Fonseca Fernanda F, Castilho Jessica, Rebeiro Peter F, Machado Daisy M, Luque Marco Tulio, Jalil Emilia M, Mejia Fernando, Kim Ahra, Shepherd Bryan E, Cortes Claudia P
Faculty of Medicine, Universidad de Chile, Santiago, Chile.
Hospital Clinico San Borja Arriaran & Fundación Arriaran, Santiago, Chile.
J Int AIDS Soc. 2025 May;28(5):e26411. doi: 10.1002/jia2.26411.
Antiretroviral therapy (ART) during pregnancy and at delivery has nearly eliminated vertical transmission (VT) in some settings but previously reported VT prevalence has been as high as 15% in Latin America and the Caribbean (LAC). We evaluated VT in the Caribbean, Central and South America network for HIV epidemiology to further study the benefit of ART on VT in our region.
We retrospectively collected data on cis-gender women ≥15 years of age enrolled in HIV clinics in Brazil, Chile, Honduras and Peru from 2003 to 2018 with ≥1 pregnancy resulting in a live birth after clinic entry to examine the association of ART use at the time of delivery and VT. We used propensity-score-matched logistic regression to examine the odds of VT by ART use. Matching weights incorporated site, HIV RNA, CD4 cell count, maternal age, year and HIV diagnosis before or during pregnancy. We also examined the proportion of women who received ART during pregnancy before and after the treat-all era, as defined within each country.
A total of 623 pregnant women with HIV contributed 727 live births. Of all births, 613 (84.3%) infants had known HIV status and there were 22 (3.6%) VT events. Four of the 22 (18%) were born to women on ART at delivery, compared to 403 of 591 (68%) infants negative for HIV. In the propensity-score-matched model, ART use at delivery was associated with 85% decreased odds of VT (odds ratio = 0.15, 95% confidence interval 0.04-0.58). In the pre-treat-all era, 37% (181/485) of women received ART within 30 days of pregnancy diagnosis, compared to 59% (75/128) during the treat-all era (p<0.001). In the pre-treat-all era, 4.3% (21/485) of infants were born HIV positive, compared to 0.8% (1/128) in the treat-all era (p = 0.055).
We found a low prevalence of VT in our cohort, especially in the treat-all era. ART use at delivery was strongly associated with a lower odd of VT. Despite improvements, access to ART during pregnancy remained far from universal. Therefore, new strategies to ensure its effective implementation in LAC are still warranted.
在某些情况下，孕期和分娩时的抗逆转录病毒疗法（ART）几乎消除了垂直传播（VT），但此前报告的拉丁美洲和加勒比地区（LAC）的VT患病率高达15%。我们评估了加勒比、中美洲和南美洲HIV流行病学网络中的VT情况，以进一步研究ART对我们地区VT的益处。
我们回顾性收集了2003年至2018年期间在巴西、智利、洪都拉斯和秘鲁的HIV诊所登记的年龄≥15岁的顺性别女性的数据，这些女性在诊所登记后至少有1次怀孕并分娩活产婴儿，以研究分娩时使用ART与VT之间的关联。我们使用倾向得分匹配的逻辑回归来研究使用ART时VT的几率。匹配权重纳入了地点、HIV RNA、CD4细胞计数、产妇年龄、年份以及怀孕前或怀孕期间的HIV诊断情况。我们还研究了在每个国家定义的“全面治疗时代”之前和之后孕期接受ART治疗的女性比例。
共有623名感染HIV的孕妇分娩了727名活产婴儿。在所有出生婴儿中，613名（84.3%）婴儿的HIV状况已知，有22例（3.6%）发生VT事件。22例中的4例（18%）婴儿的母亲在分娩时接受了ART治疗，而HIV检测呈阴性的591例婴儿中有403例（68%）。在倾向得分匹配模型中，分娩时使用ART与VT几率降低85%相关（优势比 = 0.15，95%置信区间0.04 - 0.58）。在“全面治疗时代”之前，37%（181/485）的女性在怀孕诊断后30天内接受了ART治疗，而在“全面治疗时代”这一比例为59%（75/128）（p<0.001）。在“全面治疗时代”之前，4.3%（21/485）的婴儿出生时HIV呈阳性，而在“全面治疗时代”这一比例为0.8%（1/128）（p = 0.055）。
我们发现我们队列中的VT患病率较低，尤其是在“全面治疗时代”。分娩时使用ART与较低的VT几率密切相关。尽管有所改善，但孕期获得ART的机会仍远未普及。因此，仍有必要采取新策略以确保其在拉丁美洲和加勒比地区有效实施。
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