垂直艾滋病毒传播的概率:系统审查和元回归
Magdalene K Walters1, Michelle A Bulterys2, Michael Barry3
1MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK.
The lancet. HIV
|August 3, 2025
概括
消除母婴艾滋病毒传播至关重要. 在孕妇早期开始抗逆转录病毒疗法 (ART) 显著降低了艾滋病毒传播风险,并改善了病毒载荷抑制.
科学领域:
- 公共卫生 公共卫生
- 传染性疾病 传染性疾病
- 流行病学 流行病学
背景情况:
- 全球努力的重点是消除垂直艾滋病毒传播,使用UNAIDS的频谱艾滋病影响模块 (Spectrum-AIM) 进行监测.
- 抗逆转录病毒疗法 (ART) 交付和一线治疗方案的创新旨在降低垂直HIV传播概率.
- 这项研究系统地审查和元分析数据,以根据母亲的免疫和治疗状态来估计垂直传播的概率.
研究的目的:
- 通过系统性审查和元回归,估计垂直艾滋病毒传播概率并确定关键决定因素.
- 更新现有的估计,将其纳入UNAIDS2025年艾滋病毒估计的频谱-AIM模型.
- 评估ART类和启动时间对分娩时病毒负载抑制 (VLS) 的影响.
主要方法:
- 进行了更新的系统审查和元回归,将新数据与以前的发现结合起来.
- 在多个数据库 (PubMed,Embase等) 进行了搜索. 在2018年1月至2024年2月期间进行英语语言学习.
- 利用四个元回归模型来估计垂直传输概率,并评估模型对Spectrum-AIM结果的敏感性.
主要成果:
- 对110项研究的分析表明,对于没有接受ART的女性来说,较高的CD4计数与较低的围产期传播几率相关.
- 在分娩前每增加一周的ART,将垂直传播的几率降低5.6%.
- 在分娩前20周启动基于整合酶抑制剂的ART显示,与NNRTI相比,围产期传播几率明显较低 (OR0.36);晚期启动ART与较低的VLS几率 (OR0.37) 有关.
结论:
- 垂直艾滋病毒传播概率受到母亲免疫状况,ART疗法和治疗开始时间的影响.
- 这些精确的估计已经纳入了UNAIDS"2025年艾滋病毒预测的频谱-AIM.
- 早期的ART启动与在分娩时实现病毒负载抑制的可能性增加密切相关,尽管需要对最近的ART创新进行更多研究.
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