HIV-infected women on antiretroviral treatment have increased mortality during pregnant and postpartum periods.
HIV-infected women on antiretroviral treatment have increased mortality during pregnant and postpartum periods.
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DOI：
10.1097/qad.0000000000000040
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发表时间：
2013-10
期刊：
影响因子：
--
通讯作者：
Hunt PW
中科院分区：
文献类型：
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作者：
Matthews LT;Kaida A;Kanters S;Byakwagamd H;Mocello AR;Muzoora C;Kembabazi A;Haberer JE;Martin JN;Bangsberg DR;Hunt PW
评估妊娠对开始抗逆转录病毒治疗（ART）的乌干达艾滋病毒感染妇女死亡率的影响。前瞻性队列研究。在乌干达艾滋病农村治疗结果研究中开始抗逆转录病毒疗法的艾滋病毒感染妇女每季度进行一次自我报告怀孕的评估。妊娠/产后（“妊娠相关”）随访期与死亡率之间的关系采用考克斯比例风险模型进行评估，该模型调整了年龄、CD 4细胞计数、血浆HIV-1 RNA水平和ART持续时间。354名中位年龄33岁（IQR：27-37）和CD 4 142个细胞/mm 3（IQR：82-213）的女性在ART开始后接受了中位4.0年（IQR：2.5-4.8）的随访，第1年和第3年的失访率分别为3%和6%。109名妇女怀孕。5例死亡发生在妊娠相关随访期间，16例死亡发生在非妊娠相关随访期间，ART开始后第一年的粗死亡率为12.57/100 PY和3.53/100 PY（率比3.56，95% CI：0.97-11.07）。在调整后的模型中，妊娠相关随访对死亡率的影响在ART开始时最高（aHR：21.48，95% CI：3.73 - 123.51），降至13.44（95% CI 3.28 - 55.11）4个月后，8.28（95%CI：2.38 - 28.88），1年后为5.18（95%CI：1.36 - 19.71），2年后为1.25（95%CI：0.10 - 15.58）。妊娠和产后期与艾滋病毒感染的妇女开始抗逆转录病毒治疗，特别是在早期的抗逆转录病毒治疗的死亡率增加。避孕接近抗逆转录病毒治疗的开始，早期抗逆转录病毒治疗的开始，并在产后期间仔细监测，可能会降低孕产妇死亡率在这种情况下。
To assess the impact of pregnancy on mortality among HIV-infected Ugandan women initiating antiretroviral therapy (ART). Prospective cohort study. HIV-infected women initiating ART in the Uganda AIDS Rural Treatment Outcomes study were assessed quarterly for self-reported pregnancy. The association between pregnant/postpartum (“pregnancy-related”) follow-up periods and mortality was assessed with Cox proportional hazards models adjusted for age, CD4 cell count, plasma HIV-1 RNA levels, and ART duration. 354 women with median age 33 years (IQR: 27-37) and CD4 142 cells/mm3 (IQR: 82-213) were followed for a median of 4.0 years (IQR: 2.5-4.8) after ART initiation, with 3% and 6% loss-to-follow-up at years 1 and 3. 109 women experienced pregnancy. Five deaths occurred during pregnancy-related follow-up and 16 during non-pregnancy-related follow-up, for crude mortality rates during the first year after ART initiation of 12.57/100 PYs and 3.53/100 PYs (Rate Ratio 3.56, 95% CI: 0.97-11.07). In adjusted models, the impact of pregnancy-related follow-up on mortality was highest at ART initiation (aHR: 21.48, 95% CI: 3.73 - 123.51), decreasing to 13.44 (95% CI 3.28 – 55.11) after 4 months, 8.28 (95% CI 2.38 – 28.88) after 8 months, 5.18 (95% CI: 1.36 - 19.71) after one year, and 1.25 (95% CI: 0.10 - 15.58) after two years on ART. Four of five maternal deaths occurred postpartum. Pregnancy and the postpartum period were associated with increased mortality in HIV-infected women initiating ART, particularly during early ART. Contraception proximate to ART initiation, earlier ART initiation, and careful monitoring during the postpartum period may reduce maternal mortality in this setting.