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首页> 外文期刊>JAIDS: Journal of acquired immune deficiency syndromes >Mortality during the first 24 months after delivery in relation to CD4 T-lymphocyte levels and viral load in a cohort of breast-feeding HIV-1-infected women in Dar es Salaam, Tanzania.
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Mortality during the first 24 months after delivery in relation to CD4 T-lymphocyte levels and viral load in a cohort of breast-feeding HIV-1-infected women in Dar es Salaam, Tanzania.

机译：分娩后头24个月的死亡率与坦桑尼亚达累斯萨拉姆一组母乳喂养的HIV-1感染妇女的CD4 + T淋巴细胞水平和病毒载量有关。

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The objective of this study was to analyze the mortality during the first 24 months after delivery in relation to CD4 T-lymphocyte levels and viral load at enrollment (36 weeks of gestation) in a cohort of HIV-1-seropositive breast-feeding women at the Dar es Salaam site of the multicenter Petra trial (a mother-to-child HIV-1 transmission intervention trial using antiretroviral therapy). Antiretroviral treatment was not available in this setting apart from the short treatment given within the trial around delivery to prevent mother-to-child transmission of HIV. T-lymphocyte subsets were determined by flow cytometry. Plasma HIV-1 RNA was quantified by the Amplicor HIV-1 RNA Monitor v 1.5 assay. Mortality after delivery was analyzed using the life-table technique and Cox regression. The analysis included 266 mothers. The CD4 cell counts at enrollment were <200 cells/mm in 14.5% of the mothers. The viral load at enrollment was >100,000 RNA copies/mL in 33.6% of the mothers. The mortality 24 months after delivery was 6.7% (95% CI = 3.1-10.1%). The mortality 24 months after delivery was 29.9% (95% CI = 13.1-46.9%) for mothers with <200 CD4 cells/mm at enrollment, 3.3% (95% CI = 0-6.6%) for mothers with 200-499 CD4 cells/mm, 2.9% (95% CI = 0-7.1%) for mothers with >500 CD4 cells/mm (P = 0.0000), 15.0% (95% CI = 6.6-23.4%) for mothers with viral load >100,000 copies/mL at enrollment, and 2.8% (95% CI = 0-5.6%) for mothers with viral load <100,000 copies/mL (P = 0.0000). In the multivariate analysis CD4 cell counts and viral load were both independent risk factors for mortality (P < 0.001 and P = 0.004, respectively). In conclusion, the mortality was high among women with severe immunosuppression or high viral load at enrollment, but not in the rest of the women. CD4 lymphocyte count in late pregnancy was a better predictor of death within 2 years than was viral load. The results support the World Health Organization recommendation to initiate antiretroviral treatment in resource-limited settings in HIV-1-infected adults with CD4 cell counts <200/mm and show that this is appropriate also among perinatal women.
机译：这项研究的目的是分析一组HIV-1血清阳性的母乳喂养妇女在分娩后最初24个月的死亡率，与入组（妊娠36周）的CD4 T淋巴细胞水平和病毒载量有关。多中心Petra试验（使用抗逆转录病毒疗法的母婴HIV-1传播干预试验）的Dares Salaam地点。除了在分娩前后进行短期治疗以防止母婴传播艾滋病毒外，在这种情况下还没有抗逆转录病毒治疗。通过流式细胞术确定T淋巴细胞亚群。通过Amplicor HIV-1 RNA Monitor v 1.5测定法对血浆HIV-1 RNA进行定量。使用生命表技术和Cox回归分析分娩后的死亡率。分析包括266位母亲。 14.5％的母亲入选时，CD4细胞计数<200个/ mm。 33.6％的母亲入组时的病毒载量> 100,000 RNA复制/ mL。分娩后24个月的死亡率为6.7％（95％CI = 3.1-10.1％）。分娩时CD4 <200 CD / mm的母亲分娩后24个月的死亡率为29.9％（95％CI = 13.1-46.9％），200-499 CD4的母亲为3.3％（95％CI = 0-6.6％）细胞/毫米，对于> 500 CD4细胞/毫米（P = 0.0000）的母亲，为2.9％（95％CI = 0-7.1％），对于病毒载量> 100,000的母亲，为15.0％（95％CI = 6.6-23.4％）入院时的病毒拷贝数/ mL，对于病毒载量<100,000拷贝/ mL的母亲，为2.8％（95％CI = 0-5.6％）（P = 0.0000）。在多变量分析中，CD4细胞计数和病毒载量都是死亡率的独立危险因素（分别为P <0.001和P = 0.004）。总之，入组时严重免疫抑制或高病毒载量的女性死亡率较高，但其余女性则不然。妊娠晚期，CD4淋巴细胞计数比病毒载量更好地预测了2年内的死亡。研究结果支持世界卫生组织的建议，即在资源受限的环境中对CD4细胞计数<200 / mm的HIV-1感染的成年人进行抗逆转录病毒治疗，并表明这也适用于围产期妇女。

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