Missed Opportunities Among HIV-Positive Women to Control Viral Replication During Pregnancy and to Have a Vaginal Delivery
Missed Opportunities Among HIV-Positive Women to Control Viral Replication During Pregnancy and to Have a Vaginal Delivery
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DOI：
10.1097/qai.0b013e3182a334e3
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发表时间：
2013-09-01
影响因子：
3.6
通讯作者：
Thorne, Claire
中科院分区：
文献类型：
--
作者：
Aebi-Popp, Karoline;Mulcahy, Fiona;Thorne, Claire
简介：2001年至2010年期间，欧洲大多数预防艾滋病毒母婴传播的国家指南都建议病毒载量（VL）检测不到或非常低的妇女进行阴道分娩。我们的目的是探讨这些新的指导方针对艾滋病毒阳性妇女阴道分娩率在European.Methods的影响：在一个汇总分析的数据艾滋病毒阳性孕妇登记在瑞士母亲和儿童艾滋病毒队列研究和欧洲合作研究2000年至2010年，交付被归类为发生前或出版后的国家指南推荐阴道分娩。总体而言，包括来自10个国家的2663名妇女，3013次分娩; 28%的妇女在怀孕期间被诊断出感染艾滋病毒。大多数孕妇（2020年，73%）使用了联合抗逆转录病毒治疗，78%的孕妇在妊娠早期或中期开始接受治疗，22%的孕妇在妊娠晚期开始接受治疗; 25%的孕妇接受了联合抗逆转录病毒治疗。总体而言，在86%的妊娠中，VL < 400拷贝/毫升在分娩前达到。阴道分娩的比例从指南变更前的17%（414/2377）增加到指南变更后的52%（313/600）;选择性剖腹产率从65%下降到27%。在实施新指南后，无法检测到VL的妇女进行剖腹产的比例为55%。我们观察到晚期早产率从指南变更前的16%（377/2354）下降到7%（42/599）（P < 0.001）。结论：在欧洲，HIV感染者仍然错过了完全抑制VL和阴道分娩的机会。
Introduction: Most national guidelines for the prevention of mother-to-child transmission of HIV in Europe updated between 2001 and 2010 recommend vaginal deliveries for women with undetectable or very low viral load (VL). Our aim was to explore the impact of these new guidelines on the rates of vaginal deliveries among HIV-positive women in Europe.Methods: In a pooled analysis of data on HIV-positive pregnant women enrolled in the Swiss Mother & Child HIV Cohort Study and the European Collaborative Study 2000 to 2010, deliveries were classified as occurring pre-or postpublication of national guidelines recommending vaginal delivery.Results: Overall, 2663 women with 3013 deliveries were included from 10 countries; 28% women were diagnosed with HIV during pregnancy. Combination antiretroviral therapy was used in most pregnancies (2020, 73%), starting during the first or second trimester in 78% and during the third trimester in 22%; in 25% pregnancies, the woman conceived on combination antiretroviral therapy. Overall, in 86% pregnancies, a VL < 400 copies per milliliter was achieved before delivery. The proportion of vaginal deliveries increased from 17% (414/2377) before the change in guidelines to 52% (313/600) after; elective Caesarean section rates decreased from 65% to 27%. The proportion of women with undetectable VL having a Caesarean section was 55% after implementation of new guidelines. We observed a decrease of late preterm deliveries from 16% (377/2354) before to 7% (42/599) after the change in guidelines (P < 0.001).Conclusion: There are still missed opportunities for women with HIV to fully suppress their VL and to deliver vaginally in Europe.