Optimal timing of viral load monitoring during pregnancy to predict viraemia at delivery in HIV-infected women initiating ART in South Africa: a simulation study.
Optimal timing of viral load monitoring during pregnancy to predict viraemia at delivery in HIV-infected women initiating ART in South Africa: a simulation study.
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DOI：
10.1002/jia2.25000
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发表时间：
2017-11
影响因子：
6
通讯作者：
Myer L
中科院分区：
文献类型：
--
作者：
Lesosky M;Glass T;Mukonda E;Hsiao NY;Abrams EJ;Myer L
艾滋病毒载量监测是评估抗逆转录病毒治疗效果和传播风险的核心工具。根据世界卫生组织（世卫组织）最近的建议，全球正在开展扩大VL监测的运动，但对孕妇VL监测的研究很少。我们研究了这一领域的一个重要问题：在模拟的南非人口中，在怀孕期间开始抗逆转录病毒治疗的妇女中，何时以及以何种频率监测VL，以预测分娩时的VL。我们建立了一个数学模型，利用来自妇幼保健-抗逆转录病毒治疗（MCH‐ART）队列的VL数据，模拟从受孕到分娩的VL。VL基于三个主要区室建模：ART前VL， ART启动后立即的病毒衰变和病毒维持（包括病毒抑制和病毒发作）。使用此模拟，我们检查了各种VL监控方案在预测分娩时VL升高方面的性能。如果使用世卫组织针对未怀孕成人的指南，大多数感染艾滋病毒的孕妇（69%）在怀孕期间不会接受VL检测。大多数基于开始抗逆转录病毒治疗（不论妊娠）后时间的妊娠期VL监测模型表现不佳（敏感性<50%）；基于妇女妊娠期VL测量的模型（无论抗逆转录病毒治疗的时间长短）似乎总体上表现更好（灵敏度为60%）。在所有排列中，纳入ART前VL值对预测性能的影响可以忽略不计（提高测试灵敏度和特异性<6%）。在妊娠后期，VL监测预测分娩时VL的性能一般有所改善，在妊娠36周时进行单次VL测量的效果最好。一种新型模拟模型的开发和评价表明，在妊娠期间开始抗逆转录病毒治疗的妇女中，测量相对于胎龄的VL的策略可能比相对于抗逆转录病毒治疗持续时间的策略更有用，从而支持更好地整合孕产妇和艾滋病毒保健服务。测试周转时间需要仔细考虑，点-护理VL测试可能是在交付时测量VL的最佳方法。鉴于目前在高负担国家扩大了VL监测的规模，扩大这一模拟模型的范围是很重要的。
HIV viral load (VL) monitoring is a central tool to evaluate ART effectiveness and transmission risk. There is a global movement to expand VL monitoring following recent recommendations from the World Health Organization (WHO), but there has been little research into VL monitoring in pregnant women. We investigated one important question in this area: when and how frequently VL should be monitored in women initiating ART during pregnancy to predict VL at the time of delivery in a simulated South African population. We developed a mathematical model simulating VL from conception through delivery using VL data from the Maternal and Child Health – Antiretroviral Therapy (MCH‐ART) cohort. VL was modelled based on three major compartments: pre‐ART VL, viral decay immediately after ART initiation and viral maintenance (including viral suppression and viraemic episodes). Using this simulation, we examined the performance of various VL monitoring schema in predicting elevated VL at delivery. If WHO guidelines for non‐pregnant adults were used, the majority of HIV‐infected pregnant women (69%) would not receive a VL test during pregnancy. Most models that based VL monitoring in pregnancy on the time elapsed since ART initiation (regardless of gestation) performed poorly (sensitivity <50%); models that based VL measures in pregnancy on the woman's gestation (regardless of time on ART) appeared to perform better overall (sensitivity >60%). Across all permutations, inclusion of pre‐ART VL values had a negligible impact on predictive performance (improving test sensitivity and specificity <6%). Performance of VL monitoring in predicting VL at delivery generally improved at later gestations, with the best performing option a single VL measure at 36 weeks’ gestation. Development and evaluation of a novel simulation model suggests that strategies to measure VL relative to gestational age may be more useful than strategies relative to duration on ART, in women initiating ART during pregnancy, supporting better integration of maternal and HIV health services. Testing turnaround times require careful consideration, and point‐of‐care VL testing may be the best approach for measuring VL at delivery. Broadening the scope of this simulation model in the light of current scale up of VL monitoring in high burden countries is important.
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DOI：
10.1093/cid/cix177
发表时间：
2017-06-15
期刊：
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
影响因子：
--
作者：
Negoescu DM;Zhang Z;Bucher HC;Bendavid E;Swiss HIV Cohort Study
通讯作者：
Swiss HIV Cohort Study
影响因子：
168.9
作者：
Phillips, Andrew N.;Pillay, Deenan;Lundgren, Jens D.
通讯作者：
Lundgren, Jens D.
影响因子：
6
作者：
Myer, Landon;Phillips, Tamsin K.;Abrams, Elaine J.
通讯作者：
Abrams, Elaine J.
影响因子：
9.4
作者：
Moyo, Sikhulile;Mohammed, Terence;Novitsky, Vladimir
通讯作者：
Novitsky, Vladimir
DOI：
10.1093/cid/ciw500
发表时间：
2016-11-01
期刊：
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
影响因子：
--
作者：
Haas AD;Msukwa MT;Egger M;Tenthani L;Tweya H;Jahn A;Gadabu OJ;Tal K;Salazar-Vizcaya L;Estill J;Spoerri A;Phiri N;Chimbwandira F;van Oosterhout JJ;Keiser O
通讯作者：
Keiser O