Combination antiretroviral strategies for the treatment of pregnant HIV-1-infected women and prevention of perinatal HIV-1 transmission
Combination antiretroviral strategies for the treatment of pregnant HIV-1-infected women and prevention of perinatal HIV-1 transmission
复制标题
DOI：
10.1097/00126334-200204150-00009
复制
发表时间：
2002-04-15
期刊：
影响因子：
--
通讯作者：
Blattner, W
中科院分区：
文献类型：
--
作者：
Cooper, ER;Charurat, M;Blattner, W
背景：母婴传播研究是一项前瞻性自然历史研究，自1989年开始纳入HIV-1感染孕妇及其婴儿。目的：在人群水平评估不同抗逆转录病毒疗法对围产期HIV-1传播的影响。设计：前瞻性队列研究。对1990年1月至2000年6月间1542例HIV-1感染单胎活产妇女的血浆HIV-1 RNA水平进行了连续检测。主要观察指标：婴儿HIV-1状况。未接受产前抗逆转录病毒治疗的396名妇女：10.4%(95%可信区间)。在接受齐多夫定单一治疗的710人中：186人在没有或只有一种高效药物的情况下接受双重抗逆转录病毒治疗(多抗逆转录病毒疗法)，其治愈率为3.8%(95%CI，1.1%-6.5%)；250人接受高效抗逆转录病毒治疗(HAART)的治愈率为1.2%(95%CI，0-2.5%)。传播也因母亲分娩的艾滋病毒RNA水平而异：30000份/毫升的艾滋病毒RNA水平为1.0%(趋势为p=0.0001)。在对母亲病毒载量进行调整的多因素分析中，Emery日志、分娩病毒载量增加的传播几率增加了2.4倍(95%CL 1.7-3.5)。治疗时间，以及其他因素。接受多种抗逆转录病毒疗法和HAART的妇女与接受ZDV单一疗法的妇女相比，传播疾病的优势比为0.30(95%CI。0.09-1.02)和0.27(95%CL 0.08-0.94)。结论：分娩时HIV-1RNA水平和产前抗逆转录病毒治疗与传播独立相关。治疗的保护作用随着治疗方案的复杂程度和持续时间的增加而增加。HAART与最低的传播率有关。
Context: The Women and Infants Transmission Study is a prospective natural history study that has been enrolling HIV-1-infected pregnant women and their infants since 1989.Objective: To evaluate the impact of different antiretroviral regimens on perinatal HIV-1 transmission at the population level.Design: Prospective cohort study. Plasma HIV-1 RNA levels were serially measured in 1542 HIV-1-infected women with singleton live births between January 1990 and June 2000.Main Outcome Measure: HIV-1 status of the infant.Results: HIV-1 transmission was 20.0% (95% confidence internal [CI]. 16.1%-23.9%) for 396 women who not receiving prenatal antiretroviral therapy: 10.4% (95% CI. 8.2%-12.6%) for 710 receiving zidovudine monotherapy: 3.8% (95% CI, 1.1%-6.5%) for 186 receiving dual antiretroviral therapy with no or one highly active drug (Multi-ART): and 1.2% (95% CI, 0-2.5%) for 250 receiving highly active antiretroviral therapy (HAART). Transmission also varied by maternal delivers HIV RNA level: 1.0% for 30,000 copies/mL (p = .0001 for trend). The odds of transmission increased 2.4-fold (95% CL 1.7-3.5) for emery log, increase in delivery viral load, In multivariate analyses adjusting for maternal viral load. duration of therapy, and other factors. the odds ratio for transmission for women receiving Multi-ART and HAART compared with those receiving ZDV monotherapy was 0.30 (95% Cl. 0.09-1.02) and 0.27 (95% CL 0.08-0.94). respectively.Conclusion: Levels of HIV-1 RNA at delivery and prenatal antiretroviral therapy were independently associated with transmission. The protective effect of therapy increased with the complexity and duration of the regimen. HAART was associated with the lowest rates of transmission.