Postpartum discontinuation of antiretroviral therapy and risk of maternal AIDS-defining events, non-AIDS-defining events, and mortality among a cohort of HIV-1-infected women in the United States.
Postpartum discontinuation of antiretroviral therapy and risk of maternal AIDS-defining events, non-AIDS-defining events, and mortality among a cohort of HIV-1-infected women in the United States.
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美国一群 HIV-1 感染妇女产后停止抗逆转录病毒治疗以及孕产妇艾滋病定义事件、非艾滋病定义事件和死亡率的风险。
DOI：
10.1089/apc.2009.0283
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发表时间：
2010
影响因子：
4.9
通讯作者：
Sterling,TimothyR
中科院分区：
文献类型：
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作者：
Melekhin,VladaV;Shepherd,BryanE;Jenkins,CathyA;Stinnette,SamuelE;Rebeiro,PeterF;Bebawy,SallyS;Rasbach,DanielA;Hulgan,Todd;Sterling,TimothyR
这项回顾性队列研究对1997-2008年在田纳西州纳什维尔接受高效抗逆转录病毒治疗（HAART）的HIV感染妇女进行了评估，评估了产后HAART停药对孕产妇艾滋病定义事件（ADE）、非艾滋病定义事件（non-ADE）和死亡的影响。考克斯比例风险模型比较了ADE或全因死亡与非ADE或全因死亡的发生率，竞争风险分析比较了各组间ADE或ADE相关死亡与非ADE或非ADE相关死亡的发生率。分为两组：产后停止HAART的女性（停止，n= 54）和产后继续HAART的女性（继续，n= 69）。50%是非洲裔美国人，40%以前使用过非HAART抗逆转录病毒治疗（ART），38%有非法药物使用史。中位年龄为27.5岁，基线CD 4（%）为532（34%），CD 4最低值为332个细胞/mm 3，基线和峰值HIV-1 RNA分别为2.6和4.32 log 10拷贝/毫升。继续治疗组的妇女年龄较大，基线CD 4、CD4%和CD 4最低值较低，HIV-1 RNA峰值较高。在多变量比例风险模型中，继续治疗组ADE或全因死亡和非ADE或全因死亡的风险比[95%置信区间（CI）]较低，但无统计学显著性：分别为0.50（0.12，2.12;p= 0.35）和0.69（0.24，1.95;p= 0.48）。竞争风险分析的结果相似。尽管具有与预后不良相关的特征，但产后继续HAART的妇女与停止HAART的妇女相比，ADE或死亡和非ADE或死亡的风险比点估计值较低。需要更长随访时间的大型研究来评估这种关联。
This retrospective cohort study of HIV-infected women receiving highly active antiretroviral therapy (HAART) while pregnant assessed the effect of postpartum HAART discontinuation on maternal AIDS-defining events (ADEs), non-AIDS–defining events (non-ADEs), and death 1997–2008 in Nashville, Tennessee. Cox proportional hazards models compared rates of ADE or all-cause death and non-ADE or all-cause death, and competing risks analyses compared rates of ADE or ADE-related death and non-ADE or non-ADE–related death across the groups. There were two groups: women who stopped HAART postpartum (discontinuation,n= 54) and women who continued HAART postpartum (continuation,n= 69). Fifty percent were African American, 40% had prior non-HAART antiretroviral therapy (ART) use, and 38% had a history of illicit drug use. Median age was 27.5 years, baseline CD4(%) was 532 (34%) and CD4 nadir was 332 cells/mm3, baseline and peak HIV-1 RNA were 2.6 and 4.32 log10copies per milliliter, respectively. Women in the continuation group were older, had lower baseline CD4, CD4%, and CD4 nadir, and had higher peak HIV-1 RNA. In multivariable proportional hazards models, the hazard ratios [95% confidence interval (CI)] of ADE or all-cause death and non-ADE or all-cause death were lower in the continuation group, but not statistically significantly: 0.50 (0.12, 2.12;p= 0.35) and 0.69 (0.24, 1.95;p= 0.48), respectively. The results were similar in competing risks analyses. Despite having characteristics associated with worse prognosis, women who continued HAART postpartum had lower hazard ratio point estimates for ADEs or death and non-ADEs or death than women who discontinued HAART. Larger studies with longer follow-up are indicated to assess this association.