Effects of Highly Active Antiretroviral Therapy Duration and Regimen on Risk for Mother-to-Child Transmission of HIV in Johannesburg, South Africa
Effects of Highly Active Antiretroviral Therapy Duration and Regimen on Risk for Mother-to-Child Transmission of HIV in Johannesburg, South Africa
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DOI：
10.1097/qai.0b013e3181cf9979
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发表时间：
2010-05-01
影响因子：
3.6
通讯作者：
Chersich, Matthew
中科院分区：
文献类型：
--
作者：
Hoffman, Risa M.;Black, Vivian;Chersich, Matthew
背景资料：有限的信息存在不同的高效抗逆转录病毒治疗（HAART）方案和持续时间的方案对母婴传播（MTCT）的HIV在非洲妇女谁开始治疗先进的immunosuppression.Methods的影响：2004年1月至2008年8月，1142名妇女在产前抗逆转录病毒诊所在约翰内斯堡。结果：平均年龄为30.2岁（SD = 5.0），平均基线CD 4计数为161个细胞/立方毫米（SD = 84.3）。HAART分娩时的平均持续时间为10.7周（SD = 7.4）的85%的妇女在怀孕期间开始治疗和93.4周（SD = 37.7）的那些谁成为HAART怀孕。总体母婴传播率为4.9%（43/874），HAART方案之间没有差异。接受HAART妊娠的妇女的母婴传播率低于妊娠期间接受HAART的妇女（0.7% vs 5.7%; P = 0.01）。在后一组中，治疗每增加一周，传播几率降低8%（95%置信区间：0.87至0.99，P = 0.02）。结论：晚开始HAART与母婴传播风险增加有关。需要制定战略，促进及早发现感染艾滋病毒的妇女。
Background: Limited information exists about effects of different highly active antiretroviral therapy (HAART) regimens and duration of regimens on mother-to-child transmission (MTCT) of HIV among women in Africa who start treatment for advanced immunosuppression.Methods: Between January 2004 to August 2008, 1142 women were followed at antenatal antiretroviral clinics in Johannesburg. Predictors of MTCT (positive infant HIV DNA polymerase chain reaction at 4-6 weeks) were assessed with multivariate logistic regression.Results: Mean age was 30.2 years (SD = 5.0) and median baseline CD4 count was 161 cells per cubic millimeter (SD = 84.3). HAART duration at time of delivery was a mean 10.7 weeks (SD = 7.4) for the 85% of women who initiated treatment during pregnancy and 93.4 weeks (SD = 37.7) for those who became pregnant on HAART. Overall MTCT rate was 4.9% (43 of 874), with no differences detected between HAART regimens. MTCT rates were lower in women who became pregnant on HAART than those initiating HAART during pregnancy (0.7% versus 5.7%; P = 0.01). In the latter group, each additional week of treatment reduced odds of transmission by 8% (95% confidence interval: 0.87 to 0.99, P = 0.02).Conclusions: Late initiation of HAART is associated with increased risk of MTCT. Strategies are needed to facilitate earlier identification of HIV-infected women.