Plasma viraemia in HIV-positive pregnant women entering antenatal care in South Africa
Plasma viraemia in HIV-positive pregnant women entering antenatal care in South Africa
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DOI：
10.7448/ias.18.1.20045
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发表时间：
2015-07-06
影响因子：
6
通讯作者：
Abrams, Elaine J.
中科院分区：
文献类型：
--
作者：
Myer, Landon;Phillips, Tamsin K.;Abrams, Elaine J.
前言：血浆HIV病毒载量(VL)是艾滋病毒母婴传播(MTCT)的主要决定因素，但有关VL在撒哈拉以南非洲地区孕妇人群中的数据很少。方法：对首次就诊的HIV阳性孕妇进行孕期病毒血症的横断面调查，包括一份简明的问卷和标本进行VL检测和CD4细胞计数。结果与讨论：在研究期间，共有5551名孕妇寻求产前保健，其中HIV阳性1839例(33%)，1521例(85%)。在样本中，大约三分之二的艾滋病毒阳性妇女(n=947)在第一次去ANC就诊时没有服用抗逆转录病毒药物，其余的(38%，n=574)在受孕前已经开始抗逆转录病毒治疗(ART)。对于未接受抗逆转录病毒治疗的女性，VL的中位数为3.98log(10)拷贝/毫升；在这组患者中，CD_4细胞计数10,000拷贝/毫升的敏感度为%，这增加到78%，而CD_4阈值为10,000拷贝/毫升在未接受抗逆转录病毒治疗的妇女中很常见，这表明CD_4细胞计数在识别最有可能发生MTCT的妇女方面可能不够敏感。进入ANC的妇女中有很大一部分在受孕前就开始了抗逆转录病毒治疗，在这一群体中，超过10%的人尽管使用了抗逆转录病毒药物，但VL>；仍有1000份/毫升。孕期VL监测可能有助于识别需要额外临床关注的妊娠，以将母婴传播风险降至最低，并改善母婴健康结果。
Introduction: Plasma HIV viral load (VL) is the principle determinant of mother-to-child HIV transmission (MTCT), yet there are few data on VL in populations of pregnant women in sub-Saharan Africa. We examined the distribution and determinants of VL in HIV-positive women seeking antenatal care (ANC) in Cape Town, South Africa.Methods: Consecutive HIV-positive pregnant women making their first antenatal clinic visit were recruited into a cross-sectional study of viraemia in pregnancy, including a brief questionnaire and specimens for VL testing and CD4 cell enumeration.Results & discussion: Overall 5551 pregnant women sought ANC during the study period, of whom 1839 (33%) were HIV positive and 1521 (85%) were included. Approximately two-thirds of HIV-positive women in the sample (n = 947) were not on antiretrovirals at the time of the first ANC visit, and the remainder (38%, n = 574) had initiated antiretroviral therapy (ART) prior to conception. For women not on ART, the median VL was 3.98 log(10) copies/mL; in this group, the sensitivity of CD4 cell counts 10,000 copies/mL was 64% and this increased to 78% with a CD4 threshold of 10,000 copies/mL was commonly observed in women not on ART with CD4 cell counts >350 cells/mL, suggesting that CD4 cell counts may not be adequately sensitive in identifying women at greatest risk of MTCT. A large proportion of women entering ANC initiated ART before conception, and in this group more than 10% had VL >1000 copies/mL despite ART use. VL monitoring during pregnancy may help to identify pregnancies that require additional clinical attention to minimize MTCT risk and improve maternal and child health outcomes.