防止拉丁美洲垂直传播的ART:在"治疗所有"时代,我们在哪里?
Gabriel Castillo-Rozas1,2, Fernanda F Fonseca3, Jessica Castilho4
1Faculty of Medicine, Universidad de Chile, Santiago, Chile.
Journal of the International AIDS Society
|April 28, 2025
概括
抗逆转录病毒治疗 (ART) 显著降低了孕妇垂直艾滋病毒传播 (VT) 的风险. 在拉丁美洲和加勒比地区,在分娩时持续使用ART对于预防母婴艾滋病毒传播至关重要.
科学领域:
- 流行病学 流行病学
- 公共卫生 公共卫生
- 传染性疾病 传染性疾病
背景情况:
- 艾滋病毒的垂直传播 (VT) 在拉丁美洲和加勒比地区 (LAC) 仍然是一个问题,其历史流行率高达15%.
- 在怀孕和分娩期间的抗逆转录病毒疗法 (ART) 在许多情况下在预防静脉病毒感染方面非常有效.
- 了解ART对LAC地区的VT的影响对于有针对性的干预至关重要.
研究的目的:
- 评估ART在减少LAC地区艾滋病毒感染的孕妇中静脉瘤的有效性.
- 评估在分娩时使用ART与静脉瘤的几率之间的关联.
- 检查在"全方位治疗"时代之前和之后怀孕期间ART吸收的趋势.
主要方法:
- 从巴西,智利,洪都拉斯和秘鲁 (2003-2018) 的艾滋病毒诊所回顾性数据收集.
- 包括年龄≥15岁的cis性别女性,至少有一次怀孕导致活产.
- 倾向性得分匹配后勤回归分析,以确定在分娩时使用ART和VT之间的关联,控制混因素.
主要成果:
- 总共有623名妇女贡献了727名活产,其中22名 (3.6%) 发生了VT事件.
- 在分娩时使用ART与VT的几率降低了85% (OR = 0.15).
- 在"全方位治疗"时代,ART的采用率从"全方位治疗"前的37%增加到"全方位治疗"时代的59%,VT的比例从4.3%下降到0.8%.
结论:
- 观察到VT的发病率很低,特别是在"治疗所有"时代.
- 在分娩时使用ART是对静脉瘤的强有力的保护因素.
- 尽管取得了进展,但在LAC地区,在怀孕期间普遍获得ART需要进一步的战略改进.
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