Antiretroviral therapy (ART)는 지난 수십년 동안 많은 주산기 HIV 전염을 줄이는데 의미 있는 역할을 했습니다. HIV 여성 14,630명의 새로운 분석에서 ART 중에 임신을 하였고 분만 시 억제된 viral load를 가졌던 5482명 가운데 주산기 HIV 전염은 없었습니다.
Background.
Antiretroviral therapy (ART) is remarkably effective in preventing perinatal transmission (PT) of HIV-1. We evaluated the PT rate in a population of women with widespread access to ART before conception.
Methods.
The analysis included 14 630 women living with HIV-1 who delivered from 2000 to 2017 at centers participating in the nationwide prospective multicenter French Perinatal Cohort (ANRS-EPF). PT was analyzed according to time period, timing of ART initiation, maternal plasma viral load (pVL), and gestational age at birth. No infants were breastfed, and all received neonatal prophylaxis.
Results.
PT decreased between 3 periods, from 1.1% in 2000–2005 (58/5123) to 0.7% in 2006–2010 (30/4600) and to 0.2% in 2011–2017 (10/4907; P<.001). Restriction of the analysis to the 6316/14 630 (43%) women on ART at conception, PT decreased from 0.42% (6/1434) in 2000–2005 to 0.03% (1/3117) in 2011–2017 (P=.007). Among women treated at conception, if maternal pVL was undetectable near delivery, no PT was observed regardless of the ART combination [95%CI 0-0.07] (0/5482). Among women who started ART during pregnancy and with undetectable pVL near delivery, PT was 0.57% [95%CI 0.37-0.83] (26/ 4596). Among women treated at conception but with a detectable pVL near delivery, PT was 1.08% [95%CI 0.49-2.04] (9/834). We also qualitatively described 10 cases of transmission that occurred during the 2011–2017 period.
Conclusions.
In a setting with free access to ART, monthly pVL assessment, infant ART prophylaxis, and in the absence of breastfeeding, suppressive ART initiated before pregnancy and continued throughout pregnancy can reduce PT of HIV to almost zero.
Keywords. HIV-1 perinatal transmission; prevention of perinatal transmission; antiretroviral therapy; plasma viral load monitoring; pregnancy.
