The risk of viral rebound in the year after delivery in women remaining on antiretroviral therapy

被引：26

作者：

Huntington, Susie ^{[1
,2
]}

Thorne, Claire ^{[1
]}

Newell, Marie-Louise ^{[3
]}

Anderson, Jane ^{[4
]}

Taylor, Graham P. ^{[5
]}

Pillay, Deenan ^{[2
,6
]}

Hill, Teresa ^{[2
]}

Tookey, Pat A. ^{[1
]}

Sabin, Caroline ^{[2
]}

机构：

[1] UCL, Populat Policy & Practice Programme, London NW3 2PF, England

[2] UCL, Res Dept Infect & Populat Hlth, HIV Epidemiol & Biostat Grp, London NW3 2PF, England

[3] Univ Southampton, Southampton Gen Hosp, Fac Med, Human Dev & Hlth, Southampton, Hants, England

[4] Homerton Univ Hosp NHS Fdn Trust, London, England

[5] Univ London Imperial Coll Sci Technol & Med, Sect Retrovirol & GU Med, London, England

[6] Univ KwaZulu Natal, Africa Ctr Hlth & Populat Studies, Mtubatuba, South Africa

来源：

AIDS | 2015年 / 29卷 / 17期

基金：

英国医学研究理事会;

关键词：

adherence; HAART; HIV; postpartum women; pregnant women; viral load; HIV-ASSOCIATION GUIDELINES; INFECTED PREGNANT-WOMEN; HIV-1-POSITIVE ADULTS; POSTPARTUM; ADHERENCE; LOAD; CARE; TRANSMISSION; COMBINATION; ZIDOVUDINE;

D O I：

10.1097/QAD.0000000000000826

中图分类号：

R392 [医学免疫学]; Q939.91 [免疫学];

学科分类号：

100102 ;

摘要：

Objective:The objective of this study is to assess the risk of viral rebound in postpartum women on suppressive combination antiretroviral therapy (cART).Methods:Using data from the UK Collaborative HIV Cohort (UK CHIC) study and the UK and Ireland National Study of HIV in Pregnancy and Childhood (NSHPC), women with HIV-RNA 50copies/ml or less at delivery in 2006-2011, who started life-long cART during pregnancy (n=321) or conceived on cART (n=618), were matched by age, duration on cART and time period, with at least one control (non-postpartum). The cumulative probability of viral rebound (HIV-RNA >200copies/ml) was assessed by Kaplan-Meier analysis; adjusted hazard ratios (aHRs) for the 0-3 and 3-12 months postdelivery (cases)/pseudo-delivery (controls) were calculated in Cox proportional hazards models.Results:In postpartum women who conceived on cART, 5.9% [95% confidence interval (95% CI) 4.0-7.7] experienced viral rebound by 3 months, and 2.2% (1.4-3.0%) of their controls. The risk of viral rebound was higher in postpartum women than in controls during the first 3 months [aHR 2.63 (1.58-4.39)] but not during the 3-12 months postdelivery/pseudo-delivery. In postpartum women who started cART during pregnancy, 27% (22-32%) experienced viral rebound by 3 months, and 3.0% (1.6-4.4%) of their controls. The risk of viral rebound was higher in postpartum women than in controls during both postdelivery/pseudo-delivery periods [<3 months: aHR 6.63 (3.58-12.29); 3-12 months: aHR 4.05 (2.03-8.09)].Conclusion:In women on suppressive cART, the risk of viral rebound is increased following delivery, especially in the first 3 months, which may be related to reduced adherence, indicating the need for additional adherence support for postpartum women.

引用

页码：2269 / 2278

页数：10