Postpartum Loss to HIV Care and HIV Viral Suppression among Previously Diagnosed HIV-Infected Women with a Live Birth in New York State.
Postpartum Loss to HIV Care and HIV Viral Suppression among Previously Diagnosed HIV-Infected Women with a Live Birth in New York State.
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DOI：
10.1371/journal.pone.0160775
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发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
McNutt LA
中科院分区：
文献类型：
--
作者：
Swain CA;Smith LC;Nash D;Pulver WP;Lazariu V;Anderson BJ;Warren BL;Birkhead GS;McNutt LA
在美国，艾滋病毒母婴传播已大大减少，对儿童有明显的好处。然而，很少有人知道的因素，预测产妇在产后一年的艾滋病毒护理损失。这项回顾性队列研究纳入了纽约州2008-2010年期间至少在怀孕前一年诊断为艾滋病毒感染的980名艾滋病毒阳性妇女。在分娩相关的出院后12个月内不符合以下标准的妇女被认为是艾滋病毒护理的损失：两个或两个以上的实验室检查（CD 4或艾滋病毒载量），间隔至少90天。调整后的相对危险度（aRR）和95%置信区间（CI）的产后损失的HIV护理的预测因素进行了确定与泊松回归，使用广义估计方程求解。还评估了产后一年中HIV病毒载量未受抑制（>200拷贝/mL）的情况。总体而言，24%的妇女在产后一年内因艾滋病毒护理而丧生。在孕前参与艾滋病毒护理的妇女更有可能在产后一年中失去艾滋病毒护理（aRR：2.70; 95%CI：2.09-3.49）。相比之下，低出生体重儿与艾滋病毒护理损失的可能性降低显著相关（aRR：0.72; 95% CI：0.53-0.98）。虽然75%的妇女在分娩前的最后一次病毒载量时病毒受到抑制，但只有44%的妇女在产后一年中持续受到抑制; 12%的妇女在产后一年中没有报告病毒载量检测，44%的妇女至少有一次未抑制的病毒载量检测。缺乏参与孕前艾滋病毒相关的保健预测产后艾滋病毒护理艾滋病毒阳性产妇的损失。许多妇女在产后期间病毒控制不佳，增加了疾病进展和传染性的风险。
Mother-to-child-transmission of HIV in the United States has been greatly reduced, with clear benefits for the child. However, little is known about factors that predict maternal loss to HIV care in the postpartum year. This retrospective cohort study included 980 HIV-positive women, diagnosed with HIV at least one year before pregnancy, who had a live birth during 2008–2010 in New York State. Women who did not meet the following criterion in the 12 months after the delivery-related hospital discharge were considered to be lost to HIV care: two or more laboratory tests (CD4 or HIV viral load), separated by at least 90 days. Adjusted relative risks (aRR) and 95% confidence intervals (CI) for predictors of postpartum loss to HIV care were identified with Poisson regression, solved using generalized estimating equations. Having an unsuppressed (>200 copies/mL) HIV viral load in the postpartum year was also evaluated. Overall, 24% of women were loss to HIV care during the postpartum year. Women with low participation in HIV care during preconception were more likely to be lost to HIV care during the postpartum year (aRR: 2.70; 95% CI: 2.09–3.49). In contrast, having a low birth weight infant was significantly associated with a decreased likelihood of loss to HIV care (aRR: 0.72; 95% CI: 0.53–0.98). While 75% of women were virally suppressed at the last viral load before delivery only 44% were continuously suppressed in the postpartum year; 12% had no viral load test reported in the postpartum year and 44% had at least one unsuppressed viral load test. Lack of engagement in preconception HIV-related health care predicts postpartum loss to HIV care for HIV-positive parturient women. Many women had poor viral control during the postpartum period, increasing the risk of disease progression and infectivity.