Treatment Failure, Drug Resistance, and CD4 T-Cell Count Decline Among Postpartum Women on Antiretroviral Therapy in South Africa.
Treatment Failure, Drug Resistance, and CD4 T-Cell Count Decline Among Postpartum Women on Antiretroviral Therapy in South Africa.
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DOI：
10.1097/qai.0000000000000811
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发表时间：
2016-01-01
期刊：
影响因子：
--
通讯作者：
Chaisson RE
中科院分区：
文献类型：
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作者：
Hoffmann CJ;Cohn S;Mashabela F;Hoffmann JD;McIlleron H;Denti P;Haas DW;Dooley KE;Martinson NA;Chaisson RE
我们在一项观察性队列研究中评估了接受护理的孕妇产后12个月的HIV RNA抑制、耐药性和CD 4 T细胞计数。我们前瞻性地跟踪了两组HIV感染孕妇--有或没有肺结核--从南非的产前诊所招募。在怀孕期间接受抗逆转录病毒治疗并报告在产后12个月接受治疗的妇女也包括在内。对产后12个月HIV病毒血症妇女的血清样本进行耐药性检测。在该研究的103名女性中，入组时的中位年龄和CD 4 T细胞计数分别为29岁[四分位距（IQR）：26，32]和317个细胞/mm 3（IQR：218，385）; 43名（42%）基线时患有结核病。在怀孕期间，87%的妇女达到了HIV RNA <400 c/mL，而在产后12个月时为71%（p<0.001）。与12个月时HIV RNA <400 c/mL独立相关的因素是年龄≥30岁、可检测的血浆依法韦仑浓度和妊娠时HIV RNA <400 c/mL;有可检测的病毒载量和围产期抑郁的趋势。25名妇女获得了HIV耐药结果，12名（48%）有主要耐药突变。在12个月时有病毒血症的妇女中，从分娩到12个月，CD 4 T细胞计数中位数下降了13个细胞/mm 3（IQR：-66，140）。在继续接受护理和ART的HIV感染妇女中，维持病毒控制的成功率在产后下降，CD 4 T细胞计数下降和耐药性很常见。
We assessed HIV RNA suppression, resistance, and CD4 T-cell count 12 months post-partum among pregnant women retained in care in an observational cohort study. We prospectively followed two groups of HIV-infected pregnant women - with or without tuberculosis - recruited from pre-natal clinics in South Africa. Women who received antiretroviral therapy during pregnancy and reported being on therapy 12 months post-partum were included. Serum samples from women with HIV viremia 12 months post-partum were tested for drug resistance. Of 103 women in the study, median age and CD4 T-cell count at enrollment were 29 years [interquartile range (IQR): 26, 32] and 317 cells/mm3 (IQR: 218, 385), respectively; 43 (42%) had tuberculosis at baseline. During pregnancy, 87% of the women achieved an HIV RNA <400 c/mL compared to 71% at 12 months post-partum (p<0.001). Factors independently associated with an HIV RNA <400 c/mL at 12 months were age ≥30 years, detectable plasma efavirenz concentration, and HIV RNA <400 c/mL while pregnant; there was a trend toward both a detectable viral load and peripartum depression. HIV drug resistance results were available from 25 women, 12 (48%) had major drug resistance mutations. CD4 T-cell count declined a median of 13 cells/mm3 (IQR: -66, 140) from delivery to 12 months in women with viremia at 12 months Success with maintaining virologic control declined post-partum among HIV-infected women who remained in care and on ART, and CD4 T-cell count decline and drug resistance was common.