Time to undetectable viral load after highly active antiretroviral therapy initiation among HIV-infected pregnant women
Time to undetectable viral load after highly active antiretroviral therapy initiation among HIV-infected pregnant women
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DOI：
10.1086/518284
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发表时间：
2007-06-15
影响因子：
11.8
通讯作者：
Patel, Deven
中科院分区：
文献类型：
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作者：
Patel, Deven
背景在资源丰富的地区，还没有临床试验来解决这样一个问题，即哪种高效抗逆转录病毒治疗（HAART）方案对未经抗逆转录病毒治疗的人类免疫缺陷病毒（HIV）感染孕妇的最佳病毒应答更有效。对1997年至2004年在欧洲前瞻性合作研究中登记的240名在怀孕期间开始HAART的HIV-1感染妇女的数据进行了分析。间隔删失生存模型用于评估HAART方案类型、种族、出生地区和基线免疫学和病毒学状态等因素是否与在新生儿分娩前将病毒载量抑制在不可检测水平以下所需的持续时间相关。156名女性（65%）开始了基于蛋白酶转运蛋白的HAART治疗，其中125名（80%）接受了奈非那韦治疗，其余84名女性（35%）开始了基于奈韦拉平的治疗方案。73%的妇女在分娩时达到了不可检测的病毒载量。以奈韦拉平为基础的HAART与以PI为基础的方案相比，达到病毒抑制时间的相对危险度为1.54（95%置信区间，1.05-2.26），西非与非非洲女性相比，达到病毒抑制时间的相对危险度为1.90（95%置信区间，1.16-3.12）。从HAART开始到达到不可检测的病毒载量的中位持续时间估计是接受PI为基础的HAART的女性的1.4倍，与接受奈韦拉平为基础的HAART的女性相比。基线HIV RNA载量也是通过分娩实现病毒抑制的快速性的重要预测因子，但基线免疫状态不是。在这项研究中，奈韦拉平为基础的HAART（与PI [主要是奈非那韦]为基础的HAART相比）、西非来源和基线病毒载量较低与达到病毒抑制的时间较短相关。
Background. There have been no clinical trials in resource-rich regions that have addressed the question of which highly active antiretroviral therapy (HAART) regimens are more effective for optimal viral response in antiretroviral-naive, human immunodeficiency virus (HIV)-infected pregnant women.Methods. Data on 240 HIV-1-infected women starting HAART during pregnancy who were enrolled in the prospective European Collaborative Study from 1997 through 2004 were analyzed. An interval-censored survival model was used to assess whether factors, including type of HAART regimen, race, region of birth, and baseline immunological and virological status, were associated with the duration of time necessary to suppress viral load below undetectable levels before delivery of a newborn.Results. Protease inhibitor-based HAART was initiated in 156 women (65%), 125 (80%) of whom received nelfinavir, and a nevirapine-based regimen was initiated in the remaining 84 women (35%). Undetectable viral loads were achieved by 73% of the women by the time of delivery. Relative hazards of time to achieving viral suppression were 1.54 (95% confidence interval, 1.05-2.26) for nevirapine-based HAART versus PI-based regimens and 1.90 (95% confidence interval, 1.16-3.12) for western African versus non-African women. The median duration of time from HAART initiation to achievement of an undetectable viral load was estimated to be 1.4 times greater in women receiving PI-based HAART, compared with women receiving nevirapine-based HAART. Baseline HIV RNA load was also a significant predictor of the rapidity of achieving viral suppression by delivery, but baseline immune status was not.Conclusions. In this study, nevirapine-based HAART (compared with PI [mainly nelfinavir]-based HAART), western African origin, and lower baseline viral load were associated with shorter time to achieving viral suppression.