Time of HIV Diagnosis and Engagement in Prenatal Care Impact Virologic Outcomes of Pregnant Women with HIV.
Time of HIV Diagnosis and Engagement in Prenatal Care Impact Virologic Outcomes of Pregnant Women with HIV.
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DOI：
10.1371/journal.pone.0132262
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发表时间：
2015
期刊：
影响因子：
3.7
通讯作者：
Yehia BR
中科院分区：
文献类型：
--
作者：
Momplaisir FM;Brady KA;Fekete T;Thompson DR;Diez Roux A;Yehia BR
分娩时抑制艾滋病毒对孕产妇、胎儿和公众健康都有益。为了消除艾滋病毒母婴传播，需要了解在怀孕期间使用抗逆转录病毒治疗（ART）和分娩时抑制艾滋病毒的错失机会。我们对2005-2013年在费城的836对母婴进行了回顾性分析，涉及656名感染艾滋病毒的妇女。多变量回归检验了患者（年龄、种族/民族、保险状况、药物使用）和临床因素之间的关联，如通过Kessner指数衡量的产前护理是否充足，该指数将产前护理分为不充分、中等或充分的产前护理；艾滋病毒诊断的时机；结果：怀孕期间接受抗逆转录病毒治疗，分娩时病毒得到抑制。总体而言，25%的样本在怀孕期间被诊断出感染了艾滋病毒；39%， 38%和23%的人充分，中等和不充分从事产前护理。85%的母婴对在怀孕期间接受了抗逆转录病毒治疗，但只有52%在分娩时得到抑制。调整患者因素后，在怀孕期间被诊断为艾滋病毒的夫妇接受抗逆转录病毒治疗（AOR 0.39, 95% CI 0.25-0.61）和实现病毒抑制（AOR 0.70, 95% CI 0.49-1.00）的可能性低于怀孕前诊断的夫妇。同样，与产前护理充分的妇女相比，产前护理不足的妇女接受抗逆转录病毒治疗（AOR 0.06, 95% CI 0.03-0.11）和实现病毒抑制（AOR 0.31, 95% CI 0.20-0.47）的可能性更小。在怀孕前诊断艾滋病毒并使感染艾滋病毒的妇女参与产前护理的有针对性的干预措施有可能改善围产期与艾滋病毒有关的结果。
HIV suppression at parturition is beneficial for maternal, fetal and public health. To eliminate mother-to-child transmission of HIV, an understanding of missed opportunities for antiretroviral therapy (ART) use during pregnancy and HIV suppression at delivery is required. We performed a retrospective analysis of 836 mother-to-child pairs involving 656 HIV-infected women in Philadelphia, 2005-2013. Multivariable regression examined associations between patient (age, race/ethnicity, insurance status, drug use) and clinical factors such as adequacy of prenatal care measured by the Kessner index which classifies prenatal care as inadequate, intermediate, or adequate prenatal care; timing of HIV diagnosis; and the outcomes: receipt of ART during pregnancy and viral suppression at delivery. Overall, 25% of the sample was diagnosed with HIV during pregnancy; 39%, 38%, and 23% were adequately, intermediately, and inadequately engaged in prenatal care. Eight-five percent of mother-to-child pairs received ART during pregnancy but only 52% achieved suppression at delivery. Adjusting for patient factors, pairs diagnosed with HIV during pregnancy were less likely to receive ART (AOR 0.39, 95% CI 0.25-0.61) and achieve viral suppression (AOR 0.70, 95% CI 0.49-1.00) than those diagnosed before pregnancy. Similarly, women with inadequate prenatal care were less likely to receive ART (AOR 0.06, 95% CI 0.03-0.11) and achieve viral suppression (AOR 0.31, 95% CI 0.20-0.47) than those with adequate prenatal care. Targeted interventions to diagnose HIV prior to pregnancy and engage HIV-infected women in prenatal care have the potential to improve HIV related outcomes in the perinatal period.
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影响因子：
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作者：
Clerici, M;Saresella, M;Vigano, A
通讯作者：
Vigano, A
DOI：
10.1056/nejmoa0911486
发表时间：
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期刊：
The New England journal of medicine
影响因子：
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作者：
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影响因子：
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DOI：
10.1097/00126334-200204150-00009
发表时间：
2002-04-15
期刊：
JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES
影响因子：
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作者：
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影响因子：
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作者：
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