过去三十年瑞士感染艾滋病毒妇女的早产趋势:一项多中心、前瞻性、队列研究。

IF 2.8 3区 医学 Q2 INFECTIOUS DISEASES
HIV Medicine Pub Date : 2024-05-16 DOI:10.1111/hiv.13652
Marina Lumbreras Areta, Federico E. Migliorelli Falcone, Christoph Rudin, Christian R. Kahlert, Paolo Paioni, Marc U. Baumann, Katharine Darling, Christian Polli, Begoña Martinez de Tejada
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引用次数: 0

摘要

背景:艾滋病病毒感染以及为减少围产期传播而采取的孕期管理措施与早产(PTB)有关。这种管理方式已经发生了巨大变化。我们旨在评估 34 年来瑞士女性艾滋病病毒感染者(WLWH)早产率的变化,并确定与这些变化相关的因素和干预措施:我们分析了瑞士母婴艾滋病群组研究(MoCHiV)和瑞士艾滋病群组研究(SHCS)在 1986 年至 2020 年间收集的 1238 例单胎妊娠的数据。根据当时推荐的治疗策略的变化,我们将该队列中的 PTB 发生率与三个时间段内瑞士普通人群的 PTB 发生率进行了比较。我们通过单变量和多变量逻辑回归评估了PTB与社会人口学、HIV感染和产科变量的关系:2010年之前,WLWH的PTB率最高(平均为20.4%),之后逐渐下降(平均为11.3%),但始终高于普通人群(5%)。在单变量分析中,高龄产妇、较低的 CD4 细胞数、怀孕三个月(T3)时检测到的病毒血症、服用药物和分娩方式均与肺结核和研究期间有显著相关性。PTB 与抗逆转录病毒疗法类型之间没有关联。初产妇组和足月分娩组的自然分娩率没有差异。在多变量分析中,只有T3时较高的CD4计数和阴道分娩与随着时间推移PTB的减少有明显关系:结论:过去三十年来,瑞士 WLWH 早产率大幅下降,但仍是普通人群早产率的两倍。病毒控制的改善和分娩方式的改变(如果临近分娩时病毒载量较低,建议采用阴道分娩)促成了这一进展。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Trends in preterm birth in women living with HIV in Switzerland over the last three decades: A multicentric, prospective, cohort study

Trends in preterm birth in women living with HIV in Switzerland over the last three decades: A multicentric, prospective, cohort study

Background

HIV infection and its management during pregnancy to reduce perinatal transmission has been associated with preterm birth (PTB). This management has drastically changed. We aimed to evaluate changes in rates of PTB over 34 years in women living with HIV (WLWH) in Switzerland, and to identify factors and interventions associated with these changes.

Methods

We analysed data from 1238 singleton pregnancies, prospectively collected by the Swiss Mother and Child HIV Cohort Study (MoCHiV) and the Swiss HIV Cohort Study (SHCS) between 1986 and 2020. Rates of PTB in this cohort were compared with that of the general Swiss population for three time periods according to changing treatment strategies recommended at the time. We evaluated the association of PTB with sociodemographic, HIV infection and obstetric variables in uni- and multivariate logistic regression.

Results

Rate of PTB in WLWH was highest prior to 2010 (mean 20.4%), and progressively decreased since then (mean 11.3%), but always remained higher than in the general population (5%). Older maternal age, lower CD4 count and detectable viraemia at third trimester (T3), drug consumption and mode of delivery were all significantly associated with both PTB and period of study in univariate analysis. There was no association between PTB and type of antiretroviral regimen. No difference was found in the rate of spontaneous labor between PTB and term delivery groups. Only higher CD4 count at T3 and vaginal delivery were significantly associated with a decrease in PTB over time in multivariate analysis.

Conclusions

Preterm birth in WLWH in Switzerland has drastically decreased over the last three decades, but remains twice the rate of that in the general population. Improved viral control and changes in mode of delivery (vaginal birth recommended if viral loads are low near birth) have led to this progress.

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来源期刊
HIV Medicine
HIV Medicine 医学-传染病学
CiteScore
5.10
自引率
10.00%
发文量
167
审稿时长
6-12 weeks
期刊介绍: HIV Medicine aims to provide an alternative outlet for publication of international research papers in the field of HIV Medicine, embracing clinical, pharmocological, epidemiological, ethical, preclinical and in vitro studies. In addition, the journal will commission reviews and other feature articles. It will focus on evidence-based medicine as the mainstay of successful management of HIV and AIDS. The journal is specifically aimed at researchers and clinicians with responsibility for treating HIV seropositive patients.
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