Pregnancy and HIV disease progression during the era of highly active Antiretroviral therapy
Pregnancy and HIV disease progression during the era of highly active Antiretroviral therapy
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DOI：
10.1086/520814
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发表时间：
2007-10-01
影响因子：
6.4
通讯作者：
Sterling, Timothy R.
中科院分区：
文献类型：
--
作者：
Tai, Jennifer H.;Udoji, Mercy A.;Sterling, Timothy R.
背景。在高效抗逆转录病毒治疗（HAART）可用之前，没有明确的妊娠对人类免疫缺陷病毒（HIV）疾病进展的影响。这在HAART时代还没有被评估过。我们对1997年1月至2004年12月期间有>= 1次门诊就诊的hiv感染妇女进行了一项观察性队列研究。艾滋病毒疾病进展被定义为艾滋病定义事件或死亡的发生。结果。在符合纳入标准的759名妇女中，139名（18%）曾怀孕11次，540名（71%）接受过HAART治疗。妊娠状态对HAART持续时间没有影响。11名孕妇（8%）和149名非孕妇（24%）发展为艾滋病或死亡。在包括妊娠倾向评分的Cox比例风险模型中，在控制年龄、基线CD4（+）淋巴细胞计数、基线HIV-1 RNA水平和持久病毒学抑制后，妊娠与疾病进展风险降低相关（风险比[HR]， 0.40[95%可信区间{CI}， 0.20-0.79];]）。根据年龄、基线CD4+淋巴细胞计数、接受HAART治疗和队列入组日期，对81名Pp. 009孕妇和81名非孕妇进行配对分析，孕妇在妊娠事件发生前（HR, 0.10 [95% CI, 0.01-0.89]）和之后（HR, 0.44 [95% CI, 0.19-1.00]）的疾病进展风险较低。第04页第05页结论。在这项haart时代的研究中，怀孕与较低的HIV疾病进展风险相关。这一发现可能是怀孕妇女免疫状况更健康的结果，也可能与怀孕和HAART之间有益的相互作用有关。
Background. Before the availability of highly active antiretroviral therapy ( HAART), there was no clear effect of pregnancy on human immunodeficiency virus (HIV) disease progression. This has not been assessed during the HAART era.Methods. We conducted an observational cohort study among HIV-infected women with >= 1 outpatient clinic visit between January 1997 and December 2004. HIV disease progression was defined as the occurrence of an AIDS-defining event or death. Results. Of 759 women who met the inclusion criteria, 139 (18%) had had 11 pregnancy, and 540 (71%) had received HAART. There was no difference in HAART duration by pregnancy status. Eleven pregnant (8%) and 149 nonpregnant (24%) women progressed to AIDS or death. After controlling for age, baseline CD4(+) lymphocyte count, baseline HIV-1 RNA level, and durable virologic suppression in a Cox proportional hazards model that included propensity score for pregnancy, pregnancy was associated with a decreased risk of disease progression ( hazard ratio [HR], 0.40 [95% confidence interval {CI}, 0.20-0.79];]). In a matched-pair analysis of 81 Pp. 009 pregnant women matched to 81 nonpregnant women according to age, baseline CD4+ lymphocyte count, receipt of HAART, and date of cohort entry, pregnant women had a lower risk of disease progression both before ( HR, 0.10 [ 95% CI, 0.01-0.89];) and after ( HR, 0.44 [ 95% CI, 0.19-1.00];) the pregnancy event. Pp. 04 Pp. 05Conclusion. Pregnancy was associated with a lower risk of HIV disease progression in this HAART-era study. This finding could be the result of the healthier immune status of women who become pregnant or could possibly be related to a beneficial interaction between pregnancy and HAART.