Application value of two triple highly active antiretroviral therapy in treatment of pregnant women complicated with human immunodeficiency virus infection

doi:10.3877/cma.j.issn.1674-1358.2021.02.004

Abstract

Abstract:

Objective

To compare the application value of two kinds of triple highly active antiretroviral therapy (HAART) with and without zidovudine (AZT) in the treatment of pregnant women complicated with human immunodeficiency virus (HIV) infection.

Methods

Total of 40 pregnant women with HIV infection who were admitted to Handan Infectious Diseases Hospital from January 2014 to December 2018 were selected, and were divided into two groups randomly by random number table method: observation group (20 cases) and control group (20 cases). The cases in observation group were treated with triple HAART containing AZT, which contained AZT + 3TC (lamivudine) + LPV/R (lopinavir ritonavir)/EFV (efavirenz)/NVP (nevirapine). The cases in control group were treated with triple HAART without AZT, which contained TDF (tenofovir disoproxil) + 3TC + LPV/R/EFV/NVP. All the patients began to take the medicine at the 14th week of pregnancy, and took medicine till the 6th week of postpartum. The load of plasma HIV-1 ribonucleic acid (HIV-1 RNA) and peripheral blood T-lymphocyte counts were tested before medication and one week before delivery separately. The incidence of intrahepatic cholestasis of pregnancy (ICP), amniotic fluid contamination, postpartum hemorrhage, puerperal infection of pregnant women and low birth weight (LBW) between the two groups were analyzed by Yates calibration square test. The cesarean section rates and incidence of different degrees anaemia of pregnant women and newborns of the two groups were compared by Pearson chi-square test, respectively. The birth weight and 1 min Apgar score etc. of the two groups of newborns were analyzed by t test. The incidence of neonatal asphyxia and HIV infection in the two groups of newborns after 6 months of follow-up were analyzed by Fisher exact probability method.

Results

The levels of plasma HIV-1 RNA load of cases in observation group and control group at the first week before delivery were significantly lower than those before treatment (observation group: t = 29.358, P < 0.001, control group: t = 24.858, P < 0.001), and HIV-1 RNA load of pregnant women in observation group one week before delivery was significantly lower than that of the control group, with significant difference (t = 7.203, P < 0.001). The peripheral blood CD4⁺ T lymphocyte counts and CD4⁺/CD8⁺ T of pregnant women one week before delivery in the two groups were significantly higher than those before treatment (all P < 0.05), while CD8⁺ T lymphocyte counts were significantly lower than those before treatment (observation group: t = 3.754, P = 0.001, control group: t = 2.235, P = 0.031). The peripheral blood CD4⁺ T lymphocyte count and CD4⁺/CD8⁺ T of pregnant women one week before delivery in observation group were significantly higher than those of the control group (CD4⁺ T: t = 2.199, P = 0.034; CD4⁺/CD8⁺ T: t = 2.168, P = 0.037), while the CD8⁺ T lymphocyte count was significantly lower than that of the control group (t = 2.046, P = 0.048), with significant differences. There was no significant difference in incidence of ICP, amniotic fluid pollution, postpartum hemorrhage, puerperal infection and cesarean section between the two groups (all P > 0.05). There were also no significant differences in newborns birth weight, LBW incidence, 1 min Apgar score and asphyxia rate between newborns of the two groups (all P > 0.05). The neonatal anaemia rate in the observation group was 60.00% (12/20), which was significantly higher than that in the control group [25.00% (5/20)], and the difference was statistically significant (χ² = 5.013, P = 0.025). During the follow-up period of newborns, there was no mother-to-child transmission of HIV in observation group, while in control group, there was one newborn with positive HIV nucleic acid test at the 5th week after birth. The mother-to-child transmission rate was 5.00%, without significant difference between the two groups (P = 1.000).

Conclusions

Compared with the triple HAART without AZT (TDF + 3TC + LPV/R/EFV/NVP), the triple HAART with AZT (AZT + 3TC + LPV/R/EFV/NVP) could effectively promote the recovery of immune function of pregnant women and reduce the level of HIV viral load, but the triple HAART with AZT had a higher rate of neonatal anemia.

Key words: Triple highly active antiretroviral therapy, Zidovudine, Pregnancy, Human immunodeficiency virus, Immune reconstitution, Pregnancy outcome

Caihua Wu, Shuqin Jiang, Li Zhang, Shuping Jiang, Xianhua Xiao. Application value of two triple highly active antiretroviral therapy in treatment of pregnant women complicated with human immunodeficiency virus infection[J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2021, 15(02): 92-98.

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References 26

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组别	例数	年龄（ ± s，岁）	生产史[例（%）]		HIV感染途径[例（%）]		合并感染[例（%）]
组别	例数	年龄（ ± s，岁）	初产	经产	性传播	静脉吸毒	HBV	HCV	梅毒螺旋体	发生率
观察组	20	29.2 ± 4.5	16（80.00）	4（20.00）	18（90.00）	2（10.00）	3（15.00）	1（5.00）	1（5.00）	5（25.00）
对照组	20	30.5 ± 4.3	18（90.00）	2（10.00）	20（100.00）	0（0.00）	4（20.00）	0（0.00）	0（0.00）	4（20.00）
统计量		t = 0.934	χ² = 0.196^a		χ² = 0.526^a		—			χ² = 0.000^a
P值		0.356	0.658		0.468		—			1.000

组别	例数	年龄（ ± s，岁）	生产史[例（%）]		HIV感染途径[例（%）]		合并感染[例（%）]
组别	例数	年龄（ ± s，岁）	初产	经产	性传播	静脉吸毒	HBV	HCV	梅毒螺旋体	发生率
观察组	20	29.2 ± 4.5	16（80.00）	4（20.00）	18（90.00）	2（10.00）	3（15.00）	1（5.00）	1（5.00）	5（25.00）
对照组	20	30.5 ± 4.3	18（90.00）	2（10.00）	20（100.00）	0（0.00）	4（20.00）	0（0.00）	0（0.00）	4（20.00）
统计量		t = 0.934	χ² = 0.196^a		χ² = 0.526^a		—			χ² = 0.000^a
P值		0.356	0.658		0.468		—			1.000

组别		HIV-1 RNA（log₁₀拷贝/ml）	CD4⁺ T（/ml）	CD8⁺ T（/ml）	CD4⁺/CD8⁺T
观察组
	用药前	3.90 ± 0.57	415.67 ± 86.23	1 305.45 ± 337.42	0.32 ± 0.13
	产前1周	0.13 ± 0.07	557.84 ± 121.34	986.23 ± 175.45	0.57 ± 0.18
	t值	29.358	4.271	3.754	2.235
	P值	< 0.001	< 0.001	0.001	0.031
对照组
	用药前	3.84 ± 0.62	406.75 ± 90.71	1 276.46 ± 304.56	0.33 ± 0.14
	产前1周	0.34 ± 0.11	479.10 ± 104.52	1 100.34 ± 177.25	0.45 ± 0.17
	t值	24.858	2.338	2.235	2.437
	P值	< 0.001	0.025	0.031	0.020
t₁值		0.319	0.319	0.285	0.234
P₁值		0.752	0.752	0.777	0.816
t₂值		7.203	2.199	2.046	2.168
P₂值		< 0.001	0.034	0.048	0.037

组别		HIV-1 RNA（log₁₀拷贝/ml）	CD4⁺ T（/ml）	CD8⁺ T（/ml）	CD4⁺/CD8⁺T
观察组
	用药前	3.90 ± 0.57	415.67 ± 86.23	1 305.45 ± 337.42	0.32 ± 0.13
	产前1周	0.13 ± 0.07	557.84 ± 121.34	986.23 ± 175.45	0.57 ± 0.18
	t值	29.358	4.271	3.754	2.235
	P值	< 0.001	< 0.001	0.001	0.031
对照组
	用药前	3.84 ± 0.62	406.75 ± 90.71	1 276.46 ± 304.56	0.33 ± 0.14
	产前1周	0.34 ± 0.11	479.10 ± 104.52	1 100.34 ± 177.25	0.45 ± 0.17
	t值	24.858	2.338	2.235	2.437
	P值	< 0.001	0.025	0.031	0.020
t₁值		0.319	0.319	0.285	0.234
P₁值		0.752	0.752	0.777	0.816
t₂值		7.203	2.199	2.046	2.168
P₂值		< 0.001	0.034	0.048	0.037

组别	例数	ICP [例（%）]	羊水污染[例（%）]	产后出血[例（%）]	产褥感染[例（%）]	剖宫产[例（%）]
观察组	20	2（10.00）	3（15.00）	3（15.00）	2（10.00）	11（55.00）
对照组	20	1（5.00）	4（20.00）	4（20.00）	3（15.00）	13（65.00）
χ²值		0.002^a	0.000^a	0.000^a	0.000^a	0.417^c
P值		0.967	1.000	1.000	1.000	0.519
组别	例数	出生体重（ ± s，g）	LBW [例（%）]	1 min Apgar评分（ ± s，min）	新生儿窒息[例（%）]
观察组	20	2 886.24 ± 402.45	2（10.00）	9.52 ± 1.34	1（5.00）
对照组	20	2 847.24 ± 376.28	3（15.00）	9.44 ± 1.29	0（0.00）
统计量		t = 0.317	χ² = 0.000^a	t = 0.192	—^b
P值		0.753	1.000	0.849	1.000

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