垂直艾滋病毒传播的概率:系统审查和元回归
Magdalene K Walters1, Michelle Bulterys2, Michael Barry2
1Imperial College London.
medRxiv : the preprint server for health sciences
|December 16, 2024
概括
更新的估计表明,在怀孕早期开始抗逆转录病毒治疗 (ART) 显著降低了垂直HIV传播的风险. 这些发现对于全球努力消除新的儿科艾滋病毒感染至关重要.
科学领域:
- 流行病学 流行病学
- 公共卫生 公共卫生
- 病毒学 病毒学
背景情况:
- 消除垂直艾滋病毒传播 (VT) 是全球卫生优先事项.
- 数学模型,如Spectrum-AIM,估计小儿艾滋病毒感染使用VT率按母亲的地位分层.
- 之前的VT概率估计上一次更新是在2018年,由于服务提供和ART方案的变化,需要更新.
研究的目的:
- 更新由母亲身份分层的VT概率的系统审查,以与Spectrum-AIM兼容.
- 进行对聚合研究的元回归,并估计具有统计不确定性的VT概率.
- 评估VT的决定因素,包括母亲的病毒载量和ART治疗方案类别/时间.
主要方法:
- 在多个数据库 (PubMed,Embase等) 中进行系统搜索. 对于来自随机对照试验,队列研究或观察性研究的VT同行评审文章.
- 110项研究的元回归分析,包括2018年至2024年间发表的24项新研究.
- 拟合元回归模型以估计与Spectrum-AIM分层相容的VT概率,并评估病毒载量抑制的决定因素.
主要成果:
- 对于没有接受PMTCT的女性来说,增加的CD4计数与降低围产期传播有关.
- 在怀孕期间接受ART的女性中,每一个在分娩前接受ART的额外一周,就会使静脉瘤的几率降低5.6%.
- 基于INSTI的ART疗法与基于NRTI的疗法相比,VT的几率较低,尽管这因地区而异. 晚期的ART启动影响了病毒载荷抑制.
结论:
- 垂直传播率受到母亲免疫状况,预防方案和ART启动时间的显著影响.
- 在分娩前早期启动ART与在分娩时抑制病毒载量有很强的相关性.
- 更新的VT概率估计和它们的不确定性可以改进Spectrum-AIM,改善儿科艾滋病毒发病率的估计和监测消除的进展.
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