Non-nucleoside reverse transcription inhibitor (NNRTI)-containing antiretroviral therapy (ART) for the prevention of mother to child transmission (PMTCT) of human immunodeficiency virus (HIV) has led to dramatic reductions in perinatal HIV infection in resource-constrained settings. Nonetheless, PMTCT programs are complicated by repeat pregnancies, in which long-term or repeat exposures to PMTCT regimens over time may lead to the acquisition of HIV drug resistance mutations, and consequent treatment failure. In this study, we retrospectively assessed the effectiveness of the NNRTI-based PMTCT protocol from 2008 to 2010 in The Bahamas National HIV/AIDS Program. We show that women who had been in repeat pregnancies and those who were already prescribed ART at conception were at increased risk of virologic failure, relative to treatment-inexperienced women and primigravida, respectively (AOR 3.1, 95% CI: 1.3–7.1, p = .008 and AOR 5.0, 95% CI: 1.8–14.1, p = .002). In addition, women undergoing treatment at conception were more likely to possess HIVDR mutations relative to treatment-naive women (AOR 447.1, 95% CI: 17.9–11,173.5, p = .001). Therefore, individual treatment history is a key metric determining the effectiveness of current and future PMTCT interventions. The implications of this to PMTCT programmatic success in light of the most recent WHO guidelines are discussed.

中文翻译：

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治疗经验和重复妊娠影响非核苷类逆转录抑制剂-高效抗逆转录病毒疗法预防人免疫缺陷病毒母婴传播的效果。

预防人类免疫缺陷病毒（HIV）母婴传播（PMTCT）的非核苷类逆转录抑制剂（NNRTI）抗逆转录病毒疗法（ART）导致围产期HIV在资源受限的环境中的感染显着减少。但是，PMTCT计划会因重复怀孕而变得复杂，其中长期或反复暴露于PMTCT方案可能会导致获得HIV耐药性突变，从而导致治疗失败。在这项研究中，我们回顾了2008年至2010年在巴哈马国家艾滋病毒/艾滋病计划中基于NNRTI的PMTCT协议的有效性。我们发现，曾经重复怀孕的妇女和在怀孕时已经开了抗逆转录病毒疗法的妇女，发生病毒学衰竭的风险增加，p  = .008和AOR 5.0，95％CI：1.8-14.1，p  = .002）。此外，相对于未接受过治疗的女性，接受妊娠治疗的女性更有可能具有HIVDR突变（AOR 447.1，95％CI：17.9-11,173.5，p  = .001）。因此，个体治疗史是决定当前和未来PMTCT干预措施有效性的关键指标。根据WHO的最新指南，讨论了这对PMTCT计划成功的影响。