Impact of Maternal HIV Seroconversion during Pregnancy on Early Mother to Child Transmission of HIV (MTCT) Measured at 4-8 Weeks Postpartum in South Africa 2011-2012: A National Population-Based Evaluation
Impact of Maternal HIV Seroconversion during Pregnancy on Early Mother to Child Transmission of HIV (MTCT) Measured at 4-8 Weeks Postpartum in South Africa 2011-2012: A National Population-Based Evaluation
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DOI：
10.1371/journal.pone.0125525
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发表时间：
2015-05-05
期刊：
影响因子：
3.7
通讯作者：
Shaffer, Nathan
中科院分区：
文献类型：
--
作者：
Dinh, Thu-Ha;Delaney, Kevin P.;Shaffer, Nathan
研究背景艾滋病母婴传播（MTCT）取决于艾滋病病毒感染的时间。我们估计艾滋病毒血清转换在怀孕期间（HSP）后，有一个艾滋病毒阴性的结果产前，其贡献早期母婴传播在南非（SA）。方法和FindingsBetween 2011年8月和2012年3月，我们招募了一个全国代表性的样本母婴对婴儿年龄4至8周，从578个卫生设施。数据收集包括母亲访谈、儿童健康卡审查和婴儿干血斑样本（iDBS）。对iDBS进行HIV抗体和HIV脱氧核糖核酸（HIV-DNA）检测。HSP的定义是母亲在妊娠期间自我报告HIV阴性，没有使用抗逆转录病毒药物的记录，并且匹配HIV血清阳性iDBS。我们使用了20个插补从一个均匀分布的时间，从产前报告的HIV阴性结果交付估计HSP的时间。根据iDBS中HIV-DNA的检测定义早期MTCT。估计进行了调整聚类，无反应，并加权SA的2011活births.ResultsOf 9802母婴对，2738 iDBS艾滋病毒血清阳性，包括212 HSP，导致在全国加权估计3.3%HSP（95%置信区间：2.8%-3.8%）。中位HIV血清转化时间为妊娠32.8周，28.3%（19.7%-36.9%）估计>36周。HSP的早期MTCT为10.7%（6.2%-16.8%），而已知HIV阳性的母亲的早期MTCT为2.2%（1.7%-2.8%）。虽然她们占所有母亲的2.2%和艾滋病毒感染母亲的6.7%，但HSP占早期母婴传播的26%。多变量分析表明，HSP的最高风险是在妇女谁知道婴儿的父亲是HIV感染者（调整后的危险比（aHR）4.71; 1.49-14.99），或谁已被筛选为结核病（aHR 1.82; 1.43-2.32）。在妊娠32周、分娩期间、产后6周、结核病暴露妇女和不和谐夫妇中通过重复检测来鉴定HSP可能会减少母婴传播。
BackgroundMother-to-child transmission of HIV (MTCT) depends on the timing of HIV infection. We estimated HIV-seroconversion during pregnancy (HSP) after having a HIV-negative result antenatally, and its contribution to early MTCT in South Africa (SA).Methods and FindingsBetween August 2011 and March 2012, we recruited a nationally representative sample of mother-infant pairs with infants aged 4-to-8 weeks from 578 health facilities. Data collection included mother interviews, child health-card reviews, and infant dried-blood-spots sample (iDBS). iDBS were tested for HIV antibodies and HIV-deoxyribonucleic-acid (HIV-DNA). HSP was defined as maternal self-report of an HIV-negative test during this pregnancy, no documented use of antiretroviral drugs and a matched HIV sero-positive iDBS. We used 20 imputations from a uniform distribution for time from reported antenatal HIV-negative result to delivery to estimate time of HSP. Early MTCT was defined based on detection of HIV-DNA in iDBS. Estimates were adjusted for clustering, nonresponse, and weighted by SA's 2011 live-births.ResultsOf 9802 mother-infant pairs, 2738 iDBS were HIV sero-positive, including 212 HSP, resulting in a nationally weighted estimate of 3.3% HSP (95% Confidence Interval: 2.8%-3.8%). Median time of HIV-seroconversion was 32.8weeks gestation; 28.3% (19.7%-36.9%) estimated to be >36 weeks. Early MTCT was 10.7% for HSP (6.2%-16.8%) vs. 2.2% (1.7%2.8%) for mothers with known HIV-positive status. Although they represent 2.2% of all mothers and 6.7% of HIV-infected mothers, HSP accounted for 26% of early MTCT. Multivariable analysis indicated the highest risk for HSP was among women who knew the baby's father was HIV-infected (adjusted-hazard ratio (aHR) 4.71; 1.49-14.99), or who had been screened for tuberculosis (aHR 1.82; 1.43-2.32).ConclusionsHSP risk is high and contributes significantly to early MTCT. Identification of HSP by repeat-testing at 32 weeks gestation, during labor, 6 weeks postpartum, in tuberculosis-exposed women, and in discordant couples might reduce MTCT.