Insufficient antiretroviral therapy in pregnancy: missed opportunities for prevention of mother-to-child transmission of HIV in Europe.
Insufficient antiretroviral therapy in pregnancy: missed opportunities for prevention of mother-to-child transmission of HIV in Europe.
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DOI：
10.3851/imp1849
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发表时间：
2011
影响因子：
1.2
通讯作者：
Thorne C
中科院分区：
文献类型：
--
作者：
European Collaborative Study in EuroCoord;Bailey H;Townsend C;Cortina-Borja M;Thorne C
尽管西欧的母婴传播率处于历史最低水平，但本可预防的传播仍在继续发生。产前联合抗逆转录病毒治疗（ART）的持续时间与母婴传播风险密切相关。对2000年1月至2009年7月在欧洲合作研究西欧和中欧地点登记的感染艾滋病毒的孕妇的数据进行了分析。调查未接受产前ART治疗或1-13天治疗的妇女比例，并使用logistic回归模型探讨相关因素。在2148名妇女中，142名（7%）未接受产前抗逆转录病毒治疗，从2000-03年的8%下降到2004-09年的5% （χ2 =8.73, p<0.01）。另有41例（2%）接受了1-13天的抗逆转录病毒治疗。在产前抗逆转录病毒治疗“不足”（没有或1-13天）的妇女中，有三分之一（64/171）的艾滋病毒诊断较晚（在妊娠晚期或分娩时），但有一半（85/171）是在孕前诊断出来的。早产<34周与产前第1-13天接受ART治疗相关（AOR分别为2.9 p<0.01和4.5 p<0.01）。注射吸毒史与无ART风险增加相关（AOR为2.9 p<0.01），与严重症状性HIV疾病风险降低相关（AOR为0.2,p<0.01）。在产前接受抗逆转录病毒治疗≥14天的妇女中，MTCT率为1.1%(15/1318)，在抗逆转录病毒治疗不足的妇女中为7.4%（10/136）。在过去10年中，本研究中每11名妇女中约有1名接受了不足的产前抗逆转录病毒治疗，占母婴传播的40%。这些女性中有一半被诊断为孕前，这表明她们脱离了护理。
Although mother-to-child transmission (MTCT) rates are at an all-time low in Western Europe, potentially preventable transmissions continue to occur. Duration of antenatal combination antiretroviral therapy (ART) is strongly associated with MTCT risk. Data on pregnant HIV-infected women enrolled in the Western and Central European sites of the European Collaborative Study between January 2000 and July 2009 were analysed. The proportion of women receiving no antenatal ART or 1-13 days of treatment was investigated, and associated factors explored using logistic regression models. Of 2148 women, 142 (7%) received no antenatal ART, decreasing from 8% in 2000-03 to 5% in 2004-09 (χ2 =8.73, p<0.01). A further 41 (2%) received 1-13 days of ART. A third (64/171) of women with “insufficient” (no or 1-13 days) antenatal ART had a late HIV diagnosis (in the third trimester or intrapartum), but half (85/171) were diagnosed pre-conception. Preterm delivery <34 weeks was associated with receipt of no and 1-13 days antenatal ART (AOR 2.9 p<0.01 and AOR 4.5 p<0.01 respectively). Injecting drug use history was associated with an increased risk of no ART (AOR 2.9 p<0.01) and severe symptomatic HIV disease with a decreased risk (AOR 0.2, p<0.01). MTCT rates were 1.1% (15/1318) among women with ≥14 days antenatal ART and 7.4% (10/136) among those with insufficient ART. Over the last 10 years, around 1 in 11 women in this study received insufficient antenatal ART, accounting for 40% of mother-to-child transmissions. Half of these women were diagnosed pre-conception, suggesting disengagement from care.