Bakari Hafidha Mhando, Sebeza Jackson, Ally Haji Mbwana, Fussi Hassan Fredrick, Ramadhani Habib Omari, Memiah Peter, Umutesi Djemima, Ikuzo Basile, Rwibasira Gallican
Department of Literature, Communication and Publishing, University of Dar es Salaam, Dar es Salaam 35091, Tanzania.
School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali 4285, Rwanda.
World J Virol. 2025 Jun 25;14(2):107322. doi: 10.5501/wjv.v14.i2.107322.
To prevent mother to child transmission (MTCT) of human immunodeficiency virus (HIV), sustained maternal viral load suppression (VLS) and early HIV testing among HIV exposed infants (HEI) is critical.
To investigate maternal viral load results and infant HIV testing uptake at 6-weeks, and 9-months and 18-months in Rwanda.
Between 2015 and 2022, VLS (< 200 copies/mL) was measured among pregnant women living with HIV (WLHIV) from 38-healthcare facilities. Viral loads (VL) were measured at 6-months, 12-months and 24-months, respectively. For maternal VL, the unit of analysis was visit-pair, and the pairs were created to define those with VL < 200 copies/mL at two consecutive visits as having sustained VLS, persistent viremia (VL ≥ 200 copies/mL at two consecutive visits), viral rebound (VL < 200 copies/mL at prior visit only) and newly suppressed (VL < 200 copies/mL at subsequent visit only). HEI were considered to have persistent HIV testing if they had all three HIV tests. Poisson regression models with generalized estimating equations were used to estimate the adjusted incidence rate ratio (aIRR) and 95%CI for factors associated with sustained VLS and persistent HIV testing.
A total of 1145 mother-infant pairs were analyzed. Infant HIV testing uptake at 6- weeks, 9-months and 18-months was 1145 (100.0%), 1089 (95.1%), 1006 (87.9%) respectively. Nine hundred ninety-nine HEI (87.3%) tested for HIV persistently. At 18-months, the incidence of HIV among HEI was 8 (0.7%). Of 1145 mothers, 1076 (94.0%) had ≥ 2 VL results making a total of 2010 visit-pairs (142-single; 934-double visit-pairs). The incidence rate of sustained VLS, persistent viremia, viral rebound and new suppression were 91.0%, 1.3%, 3.6% and 4.0% respectively. Maternal disclosure of HIV status (aIRR = 1.08, 95%CI: 1.02-1.14) was associated with increased likelihood of sustained VLS. Having peer support (aIRR = 1.05 95%CI: 1.01-1.10) was associated with persistent HIV testing among HEI.
Sustained VLS is high among pregnant WLHIV in Rwanda. The low incidence of HIV among HEI may be attributed to high VLS levels. Targeted interventions, including enhanced HIV disclosure and peer support, are crucial for improving sustained VLS and increasing infant HIV testing uptake to reduce MTCT.
为预防人类免疫缺陷病毒（HIV）的母婴传播（MTCT），持续抑制孕产妇病毒载量（VLS）以及对暴露于HIV的婴儿（HEI）进行早期HIV检测至关重要。
调查卢旺达6周龄、9月龄和18月龄时孕产妇病毒载量结果及婴儿HIV检测情况。
2015年至2022年期间，对来自38家医疗机构的感染HIV的孕妇（WLHIV）进行了病毒载量（VLS，<200拷贝/毫升）检测。分别在6个月、12个月和24个月时测量病毒载量（VL）。对于孕产妇VL，分析单位是就诊对，创建这些对是为了将连续两次就诊时VL<200拷贝/毫升的定义为持续VLS，持续病毒血症（连续两次就诊时VL≥200拷贝/毫升），病毒反弹（仅前一次就诊时VL<200拷贝/毫升）和新抑制（仅后续就诊时VL<200拷贝/毫升）。如果HEI进行了全部三次HIV检测，则认为其进行了持续HIV检测。使用带有广义估计方程的泊松回归模型来估计与持续VLS和持续HIV检测相关因素的调整发病率比（aIRR）和95%置信区间。
共分析了1145对母婴。6周龄、9月龄和18月龄时婴儿HIV检测率分别为1145例（100.0%）、1089例（95.1%）、1006例（87.9%）。999例HEI（87.3%）进行了持续HIV检测。18月龄时，HEI中HIV发病率为8例（0.7%）。在1145名母亲中，1076名（94.0%）有≥2次VL结果，共2010个就诊对（142个单次；934个双次就诊对）。持续VLS、持续病毒血症、病毒反弹和新抑制的发病率分别为91.0%、1.3%、3.6%和4.0%。孕产妇披露HIV感染状况（aIRR = 1.08，95%CI：1.02 - 1.14）与持续VLS可能性增加相关。获得同伴支持（aIRR = 1.05，95%CI：1.01 - 1.10）与HEI中持续HIV检测相关。
卢旺达感染HIV的孕妇中持续VLS水平较高。HEI中HIV低发病率可能归因于较高的VLS水平。有针对性的干预措施，包括加强HIV披露和同伴支持，对于改善持续VLS和提高婴儿HIV检测率以减少MTCT至关重要。
