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首页> 外文期刊>AIDS Research and Human Retroviruses >Full Viral Suppression, Low-Level Viremia, and Quantifiable Plasma HIV-RNA at the End of Pregnancy in HIV-Infected Women on Antiretroviral Treatment
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Full Viral Suppression, Low-Level Viremia, and Quantifiable Plasma HIV-RNA at the End of Pregnancy in HIV-Infected Women on Antiretroviral Treatment

机译：在接受抗逆转录病毒治疗的HIV感染妇女的妊娠末期，全面抑制病毒，低水平病毒血症和可量化的血浆HIV-RNA

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There is limited information on full viral suppression and low-level HIV-RNA viremia in HIV-infected women at the end of pregnancy. We investigated HIV-RNA levels close to delivery in women on antiretroviral treatment in order to define rates of complete suppression, low-level viremia, and quantifiable HIV-RNA, exploring as potential determinants some clinical and viroimmunological variables. Plasma samples from a national study in Italy, collected between 2003 and 2012, were used. According to plasma HIV-RNA levels, three groups were defined: full suppression (target not detected), low-level viremia (target detected but < 37 copies/ml), and quantifiable HIV-RNA (>= 37 copies/ml). Multivariable logistic regression was used to define determinants of full viral suppression and of quantifiable HIV-RNA. Among 107 women evaluated at a median gestational age of 35 weeks, 90 (84.1%) had HIV-RNA < 37 copies/ml. Most of them (59/90, 65.6%) had full suppression, with the remaining (31/90, 34.4%) showing low-level viremia (median: 11.9 copies/ml; IQR 7.4-16.3). Among the 17 women with quantifiable viral load, median HIV-RNA was 109 copies/ml (IQR 46-251), with only one case showing resistance (mutation M184V; rate: 9.1%). In multivariable analyses, women with higher baseline HIV-RNA levels and with hepatitis C virus (HCV) coinfection were significantly more likely to have quantifiable HIV-RNA in late pregnancy. Full viral suppression was significantly more likely with non-nucleoside reverse transcriptase inhibitor (NNRTI)-based regimens and significantly less likely with higher HIV-RNA in early pregnancy. No cases of HIV transmission occurred. In conclusion, HIV-infected pregnant women showed a high rate of viral suppression and a low resistance rate before delivery. In most cases no target HIV-RNA was detected in plasma, suggesting a low risk of subsequent virological rebound and development of resistance. Women with high levels of HIV-RNA in early pregnancy and those who have concomitant HCV infection should be considered at higher risk of having quantifiable HIV-RNA at the end of pregnancy.
机译：在妊娠末期，有关HIV感染妇女的完全病毒抑制和低水平HIV-RNA病毒血症的信息有限。为了确定完全抑制，低水平病毒血症和可量化HIV-RNA的发生率，我们调查了接受抗逆转录病毒治疗的女性接近分娩的HIV-RNA水平，并探讨了一些临床和病毒免疫学变量作为潜在的决定因素。使用了从2003年至2012年在意大利进行的一项国家研究的血浆样本。根据血浆中HIV-RNA的水平，分为三组：完全抑制（未检测到目标），低水平病毒血症（已检测到目标，但<37拷贝/毫升）和可量化的HIV-RNA（> = 37拷贝/毫升）。多变量logistic回归用于定义完全病毒抑制和可量化HIV-RNA的决定因素。在107名平均孕龄为35周的妇女中，有90名（84.1％）的HIV-RNA <37拷贝/毫升。其中大多数（59/90，65.6％）具有完全抑制作用，其余（31/90，34.4％）显示低水平的病毒血症（中位数：11.9拷贝/ ml; IQR 7.4-16.3）。在17名可量化病毒载量的妇女中，HIV-RNA的中位数为109拷贝/毫升（IQR 46-251），只有1例表现出耐药性（突变M184V;比率：9.1％）。在多变量分析中，基线HIV-RNA水平较高且丙型肝炎病毒（HCV）合并感染的妇女在妊娠晚期明显更有可能具有可量化的HIV-RNA。基于非核苷类逆转录酶抑制剂（NNRTI）的治疗方案，完全病毒抑制的可能性明显更高，而在妊娠早期，使用较高的HIV-RNA的可能性则大大降低。没有发生艾滋病毒传播病例。总之，感染艾滋病毒的孕妇在分娩前表现出较高的病毒抑制率和较低的耐药率。在大多数情况下，血浆中未检测到目标HIV-RNA，表明随后病毒学反弹和耐药性形成的风险较低。怀孕初期HIV-RNA水平高的妇女和伴有HCV感染的妇女，在妊娠末期具有可量化HIV-RNA的较高风险。

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