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HIV阳性孕产妇HARRT治疗后的病毒载量变化及母婴阻断效果分析

Analysis on HIV viral load and mother-infant transmission among HIV-infected maternal women after HARRT therapy

摘要:

目的 分析HIV阳性孕产妇参加高效抗病毒治疗(highly active antiretroviral therapy,HARRT)后的病毒载量(viral load,VL)变化及母婴阻断效果.方法 于2013-2016年,在广西壮族自治区灵山地区,选取接受HARRT治疗的HIV感染的孕产妇及其所生婴儿各101名,根据用药时间不同,分为产时用药组(12例)和孕期及孕前用药组(89例),于入组时、产后12个月对孕产妇进行VL检测.比较两组孕产妇入组时和产后12个月VL的差异;比较两组间HIV母婴传播率和孕产妇所生婴儿不良结局发生的差异.结果 101名孕产妇年龄为19~38岁,产时用药组孕产妇入组时和产后12个月时VL的M(P25,P75)分别为8233 (312,33 187)和384(50,3 788)拷贝/mL,差异无统计学意义(Z=-1.51,P=0.131);而孕期及孕前用药组孕产妇入组时VL为280(50,3 600)拷贝/mL,高于产后12个月时50(50,193)拷贝/mL(Z=-4.60,P<0.01).根据婴幼儿随访18个月时HIV诊断结果,孕期及孕前用药组无婴儿感染HIV,而产时用药组母婴传播率为33.3%,差异有统计学意义(P<0.01).结论 孕期尽早开始抗病毒治疗者相对临产紧急用药者产妇自身病毒载量和母婴传播率均更低.HIV感染孕产妇应尽可能早的进行抗病毒治疗.

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abstracts:

Objective To analysis the changes of viral load (VL) and the effects of matemal and child block among HIV positive maternal women participated in high active antiviral therapy (HARRT).Methods From 2013 to 2016,101 HIV-infected maternal women receiving HARRT treatment and their babies from Lingshan County,Guangxi Zhuang Autonomous Region were recruited and were groups into treatment at delivery group (12 cases) and treatment before and during pregnancy group (89 cases) based onstarting time of antiviral treatment.VLs were tested at the time of entering groups,12 months after delivery.The difference between VLs at the time of entering group and 12 months after delivery were compared.Vertical transmission rates and ratios of adverse outcome among newborns in both groups were estimated.Results The ages of 101 HIV-infected maternal women were from 19 to 38 years old.The M (P25,P75) of VL at the time of entering group and 12 months after delivery in treatment at delivery group were 8 233 (312,33 187) and 384 (50,3 788) copies/mL,respectively,and the difference was not statistically significant (Z=-1.51,P=-0.131).In treatment before and during pregnancy group,VL at the time of entering group was 280 (50,3 600) copies/mL and was higher than the VL of 50 (50,193) copies/mL at 12 months after delivery (Z =-4.60,P < 0.01).All infants were followed for 18 months.No infant in treatment before and during pregnancy group was infected and the transmission rate was 33.33% in treatment at delivery group.The difference was statistically significant (P<0.01).Conclusions HIV-infected maternal women receiving HARRT at early stage of pregnancy will decrease the viral load and the risk of mother-infant transmission more efficiently than those who received urgent treatment at delivery.HIV-infected maternal women should receive antiviral therapy as early as possible.

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作者: 陈巧佩 [1] 张园园 [2] 王前 [3] 佘尚扬 [1] 姚均 [2]
第一作者: 陈巧佩
期刊: 《国际病毒学杂志》2018年25卷4期 271-274页 ISTIC
栏目名称: 论著
DOI: 10.3760/cma.j.issn.1673-4092.2018.04.017
发布时间: 2018-09-20
基金项目:
国家“艾滋病和病毒性肝炎等重大传染病防治”科技重大专项 China National Key Projects for Prevention and Control of HIV/AIDS,Viral Hepatitis and other Major Infectious Diseases
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