Optimal time on HAART for prevention of mother-to-child transmission of HIV.
Optimal time on HAART for prevention of mother-to-child transmission of HIV.
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DOI：
10.1097/qai.0b013e318229147e
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发表时间：
2011-10-01
期刊：
影响因子：
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通讯作者：
Stringer EM
中科院分区：
文献类型：
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作者：
Chibwesha CJ;Giganti MJ;Putta N;Chintu N;Mulindwa J;Dorton BJ;Chi BH;Stringer JS;Stringer EM
目的：确定从开始高效抗逆转录病毒治疗(HAART)到产前HAART分娩持续时间对围产期HIV感染的影响。我们对赞比亚卢萨卡感染艾滋病毒的孕妇进行了回顾性队列分析。我们队列中的妇女接受了HAART，并在出生3至12周时进行了婴儿艾滋病毒聚合酶链式反应(PCR)检测。我们检查了与婴儿HIV感染相关的因素，并进行了局部加权回归分析，以检查产前HAART持续时间对围产期HIV感染的影响。从2007年1月至2010年3月，1,813名感染艾滋病毒的孕妇符合纳入标准。第一次产前检查的平均孕周为21周(标准差(SD)+/−6)，CD+细胞计数的中位数为231个/ul(四分位数范围164~329)，产前HAART的中位数持续时间为13周(IQR8~19)。59例(3.3%)婴儿感染HIV。产前HAART持续时间是围产期HIV传播的最重要预测因子。与分娩前至少13周开始抗逆转录病毒治疗的妇女相比，接受≤抗逆转录病毒治疗4周的妇女感染艾滋病毒的几率增加5.2倍(95%可信区间：2.5-11.0)。局部加权回归分析表明，产前HAART超过13周的额外预防益处有限。在非洲的方案环境中，可以实现低母婴艾滋病毒传播率。预防母婴传播(PMTCT)计划的最大效果是在分娩前至少13周启动HAART。
To determine the impact of time between initiating highly active antiretroviral therapy (HAART) and delivery – duration of antenatal HAART – on perinatal HIV infection. We conducted a retrospective cohort analysis of pregnant HIV-infected women in Lusaka, Zambia. Women in our cohort were receiving HAART and had an infant HIV polymerase chain reaction (PCR) test between 3 and 12 weeks of life. We examined factors associated with infant HIV infection and performed a locally weighted regression analysis to examine the effect of duration of antenatal HAART on perinatal HIV infection. From January 2007 to March 2010, 1,813 HIV-infected pregnant women met inclusion criteria. Mean gestational age at first antenatal visit was 21 weeks (standard deviation (SD)+/−6), median CD4+ cell count was 231 cells/uL (interquartile range (IQR) 164 – 329), and median duration of antenatal HAART was 13 weeks (IQR 8 – 19). 59 (3.3%) infants were HIV-infected. Duration of antenatal HAART was the most important predictor of perinatal HIV transmission. Compared to women initiating HAART at least 13 weeks prior to delivery, women on HAART for ≤ 4 weeks had a 5.2-fold increased odds of HIV transmission (95% confidence interval (CI): 2.5 –11.0). Locally weighted regression analysis suggested limited additional prophylactic benefit beyond 13 weeks on antenatal HAART. Low rates of mother-to-child HIV transmission can be achieved within programmatic settings in Africa. Maximal effectiveness of prevention of mother-to-child transmission (PMTCT) programs is achieved by initiating HAART at least 13 weeks prior to delivery.