Brochon Jeanne, Lee Terry, Brophy Jason, Singer Joel, Metras Marie-Elaine, Comeau Jeannette, Tse-Chang Alena, McConnell Athena, Money Deborah, Boucoiran Isabelle, Sauve Laura J, Bitnun Ari, Kakkar Fatima
Division of Pediatric Infectious, Department of Pediatrics, CHU Sainte Justine, Université de Montréal, Montréal, Quebec, Canada.
CIHR Pan-Canadian Network for HIV & STBBI Clinical Trials Research, Vancouver, British Columbia, Canada.
J Int AIDS Soc. 2025 Jun;28(6):e26510. doi: 10.1002/jia2.26510.
Presumptive HIV therapy (PHT) is recommended for post-natal HIV prophylaxis (PNP) in situations at high risk of HIV vertical transmission (VT), for both prevention of transmission and as early treatment in cases of in utero transmission. The objective of this study was to describe the risk of VT and use PHT among newborns in Canada, and specifically, factors associated with the use of PHT.
Data were analysed for all mother-infant pairs (MIPs) in the Canadian Perinatal HIV Surveillance Program (1997-2020), collected annually from 22 perinatal HIV centres in Canada. Infants were categorized as high risk (delivery viral load [dVL] ≥1000 copies/ml or maternal combined antiretroviral [cART] <4 weeks prior to delivery), moderate risk (dVL detectable and <1000 copies/ml, and maternal cART ≥4 weeks prior to delivery) and low risk (dVL undetectable and maternal cART ≥4 weeks prior to delivery). Neonatal prophylaxis and HIV transmission risk were compared between groups.
A total of 4743 MIPs were included in the analysis. Overall, 13.3% of newborns received PHT; the most prescribed PHT regimens included combinations using zidovudine, lamivudine and nelfinavir (48.5%) or nevirapine (41.9%). While the most significant risk factor for transmission on univariate analysis was a detectable dVL ≥1000 copies/ml versus undetectable (odds ratio [OR] 27.91 [11.20-69.54]), the risk remained significantly increased at dVL between 400 and 999 copies/ml (OR 31.71 [8.31-120.98], but not at dVL between 50 and 399 copies/ml (OR 3.03 [0.72-12.81]). At dVL 50-399 copies/ml, 29.8% of infants received PHT, increasing to 46.7% at dVL 400-999 copies/ml, and 64.4% of infants at dVL≥1000 copies/ml. The overall risk of transmission was 6% in the high-risk group, 0.5% in the moderate-risk group and 0.2% in the low-risk group.
PHT has been widely used in Canada in situations at high risk of VT, with 25% of newborns in this risk group receiving PHT as PNP. While PHT may reduce the risk of VT in high-risk situations and may be of benefit in cases of VT, these data also highlight ongoing gaps in perinatal HIV prevention in Canada.
对于存在垂直传播（VT）高风险的情况，推荐采用推定的HIV治疗（PHT）进行产后HIV预防（PNP），这既能预防传播，也能用于子宫内传播病例的早期治疗。本研究的目的是描述加拿大新生儿的VT风险及PHT的使用情况，特别是与PHT使用相关的因素。
对加拿大围产期HIV监测项目（1997 - 2020年）中的所有母婴对（MIP）数据进行分析，这些数据每年从加拿大22个围产期HIV中心收集。婴儿被分为高风险（分娩时病毒载量[dVL]≥1000拷贝/毫升或母亲联合抗逆转录病毒治疗[cART]在分娩前<4周）、中度风险（dVL可检测且<1000拷贝/毫升，母亲cART在分娩前≥4周）和低风险（dVL不可检测且母亲cART在分娩前≥4周）。比较了各组之间的新生儿预防措施和HIV传播风险。
分析共纳入4743对母婴对。总体而言，13.3%的新生儿接受了PHT；最常用的PHT方案包括齐多夫定与拉米夫定及奈非那韦联合使用（48.5%）或奈韦拉平（41.9%）。单因素分析中，传播的最显著风险因素是可检测到的dVL≥1000拷贝/毫升与不可检测相比（比值比[OR] 27.91 [11.20 - 69.54]），dVL在400至999拷贝/毫升时风险仍显著增加（OR 31.71 [8.31 - 120.98]），但dVL在50至399拷贝/毫升时风险未增加（OR 3.03 [0.72 - 12.81]）。dVL在50 - 399拷贝/毫升时，29.8%的婴儿接受了PHT，dVL在400 - 999拷贝/毫升时这一比例增至46.7%，dVL≥1000拷贝/毫升时为64.4%。高风险组的总体传播风险为6%，中度风险组为0.5%，低风险组为0.2%。
在加拿大，PHT已在VT高风险情况下广泛使用，该风险组中25%的新生儿接受PHT作为PNP。虽然PHT可能降低高风险情况下的VT风险，且在VT病例中可能有益，但这些数据也凸显了加拿大围产期HIV预防方面仍存在的差距。
