Population attributable fractions for late postnatal mother-to-child transmission of HIV-1 in Sub-Saharan Africa.
Population attributable fractions for late postnatal mother-to-child transmission of HIV-1 in Sub-Saharan Africa.
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DOI：
10.1097/qai.0b013e3181d61c2e
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发表时间：
2010-07
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影响因子：
--
通讯作者：
Read JS
中科院分区：
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作者：
Chen YQ;Young A;Brown ER;Chasela CS;Fiscus SA;Hoffman IF;Valentine M;Emel L;Taha TE;Goldenberg RL;Read JS
在HIV-1暴露婴儿队列中评估人类免疫缺陷病毒-1（HIV-1）晚期产后传播（LPT）的人群归因分数（PAF）。我们使用的数据是从一项在三个撒哈拉以南非洲国家进行的围产期临床试验的LPT风险因素分析（4-6周访视时HIV-1结果为阴性，但此后12个月访视时检测结果为阳性）中获得的。PAF计算为归因于已确定风险因素的过量LPT的比例。在1317名婴儿的队列中，206名（15.6%）仅具有低母体CD 4+计数（< 200个细胞/mm 3），332名（25.2%）仅具有高母体血浆病毒载量（VL）（> 50 000拷贝/mL），81名（6.2%）具有低CD 4+计数和高VL。其PAF分别为26.0% [95%置信区间（CI），12.0%-36.0%]、37.0%（95% CI，22.0%-51.0%）和16.0%（95% CI，6.0%-25.0%）。我们的PAF分析说明了低CD 4+计数和高VL的高危妇女占LPT的相当大比例的公共卫生影响。鉴于这些结果，感染HIV-1的高危孕妇获得和使用抗逆转录病毒疗法至关重要。对于那些不符合ART标准的患者，应实施额外的策略来减少LPT。
Assess population attributable fractions (PAFs) for late postnatal transmission (LPT) of human immunodeficiency virus-1 (HIV-1) in a cohort of HIV-1-exposed infants. We used data established from a risk factor analysis of LPT (negative HIV-1 results through the 4-6 week visit, but positive assays thereafter through the 12-month visit) from a perinatal clinical trial conducted in three sub-Saharan countries. PAFs were calculated as the proportions of excess LPTs attributed to identified risk factors. For the cohort of 1317 infants, 206 (15.6%) had only low maternal CD4+ counts (< 200 cells/mm3), 332 (25.2%) had only high maternal plasma viral loads (VLs) (> 50 000 copies/mL), and 81 (6.2%) had both low CD4+ counts and high VLs. Their PAFs were 26.0% [95% confidence interval (CI), 12.0%-36.0%], 37.0% (95% CI, 22.0%-51.0%) and 16.0% (95% CI, 6.0%-25.0%), respectively. Our PAF analysis illustrates the public health impact of the substantial proportion of LPTs accounted for by high-risk women with both low CD4+ counts and high VLs. In light of these results, access to and use of antiretroviral therapy (ART) by high-risk HIV-1-infected pregnant women is essential. Additional strategies to reduce LPT for those not meeting criteria for ART should be implemented.