美国马萨诸塞州总医院Caitlin M Dugdale团队对估计母体病毒载量对围产期和产后艾滋病毒传播的影响进行了系统综述和荟萃分析。2025年7月10日，《柳叶刀》杂志发表了这一成果。

尽管越来越多的证据支持持续病毒学抑制的人的性传播艾滋病毒的风险为零，即U=U（不可检测等于不可传播），但数据还不足以确定艾滋病毒垂直传播是否也是如此。研究组进行了一项系统综述和荟萃分析，以量化孕产妇HIV病毒载量（mHVL）的垂直传播风险，并评估U=U在围产期和产后HIV传播中的适用性。

在这项系统评价和荟萃分析中，研究组检索了PubMed、Embase、Web of Science、Cochrane图书馆、护理和相关卫生文献累积索引、WHO全球卫生图书馆，以及国际艾滋病学会会议和逆转录病毒和机会性感染会议（2016-24）1989年1月1日至2024年12月31日发表的研究。报告接近分娩时（估计6周内围产期传播风险）或母乳喂养期间（估计过去6个月内每月通过mHVL进行产后传播风险）的mHVL与垂直传播之间的关系。

研究组汇总了预先指定的mHVL类别的围产期和产后传播风险。他们还使用泊松meta回归进行了比较分析，以确定mHVL传播的调整相对风险（aRR）。该分析方案已在国际前瞻性系统评价登记册(PROSPERO；CRD42019146768)。

147项研究被纳入分析；138项研究对围产期分析有贡献，13项研究对产后分析有贡献。所有数据分析均包括82723对母子。合并围产期传播风险为0.2%（95%CI 0.2-0.3），mHVL<50拷贝/mL为1.3%（1.0-1.7），50-999拷贝/mL为5.1%（2.6-7.9），≥1000拷贝/mL。围产期传播的aRR分别为6.3（3.9-10.3）和22.5（13.9-36.5），mHVL≥1000拷贝/mL和<50拷贝/mL。在亚组分析中，五项研究报告了4675名接受孕前抗逆转录病毒治疗的妇女。（ART）出生时mHVL<50拷贝/mL，围产期传播为零（0%，0.0–0.1）。最近mHVL<50拷贝/mL的月产后传播风险为0.1%（0.0–0.4），mHVL≥50拷贝/mL的月产后感染风险为0.5%（0.1–1.8）。

研究结果表明，mHVL为50拷贝/mL的围产期传播总体上≤0.2%。在孕前接受抗逆转录病毒治疗的妇女中观察到零传播，分娩前后mHVL为50拷贝/mL，支持怀孕和分娩时U=U。产后传播非常低，但在最近mHVL为50拷贝/mL的妇女中不是零。目前的数据主要来自缺乏频繁的mHVL监测或现代一线抗逆转录病毒治疗方案的研究，不足以评估母乳喂养期间的U=U。

附：英文原文

Title: Estimating the effect of maternal viral load on perinatal and postnatal HIV transmission: a systematic review and meta-analysis

Author: Caitlin M Dugdale, Ogochukwu Ufio, John Giardina, Fatma Shebl, Elif Coskun, Eden Pletner, Pamela R Torola, Duru Cosar, Roger Shapiro, Maria Kim, Lynne Mofenson, Andrea L Ciaranello

Issue&Volume: 2025-07-10

Abstract:

Background

Although a growing body of evidence supports zero risk of sexual HIV transmission from a person with sustained virological suppression, known as U=U (undetectable equals untransmittable), data have been insufficient to determine whether this is also true for vertical HIV transmission. We conducted a systematic review and meta-analysis to quantify vertical transmission risk by maternal HIV viral load (mHVL) and to evaluate the applicability of U=U to perinatal and postnatal HIV transmission.

Methods

In this systematic review and meta-analysis, we searched PubMed, Embase, Web of Science, Cochrane Library, Cumulative Index of Nursing and Allied Health Literature, the WHO Global Health Library, and abstracts from the International AIDS Society Conference and the Conference on Retroviruses and Opportunistic Infections (2016–24) for studies published from Jan 1, 1989, to Dec 31, 2024, reporting the relationship between mHVL near birth (to estimate perinatal transmission risk by 6 weeks) or during breastfeeding (to estimate monthly postnatal transmission risk by mHVL within the past 6 months) and vertical transmission. We pooled risks of perinatal and postnatal transmission across prespecified mHVL categories. We also conducted comparative analyses to determine the adjusted relative risk (aRR) of transmission by mHVL using Poisson meta-regression. The protocol for this analysis is registered on the International Prospective Register of Systematic Reviews (PROSPERO; CRD42019146768).

Findings

147 studies were included in the analysis; 138 studies contributed to perinatal analyses and 13 studies contributed to postnatal analyses. Data on 82723 mother–child pairs were included across all analyses. Pooled perinatal transmission risks were 0·2% (95% CI 0·2–0·3) with a mHVL of <50 copies per mL, 1·3% (1·0–1·7) with 50–999 copies per mL, and 5·1% (2·6–7·9) with ≥1000 copies per mL. aRRs of perinatal transmission were 6·3 (3·9–10·3) with a mHVL of 50–999 copies per mL and 22·5 (13·9–36·5) with ≥1000 copies per mL versus <50 copies per mL. In subgroup analyses, in five studies reporting on 4675 women receiving pre-conception antiretroviral therapy (ART) with a mHVL of <50 copies per mL near birth, there were zero (0%, 0·0–0·1) perinatal transmissions. Monthly postnatal transmission risks were 0·1% (0·0–0·4) with recent mHVL <50 copies per mL and 0·5% (0·1–1·8) with a mHVL of ≥50 copies per mL.

Interpretation

Perinatal transmission with a mHVL of <50 copies per mL is ≤0·2% overall. Zero transmissions were observed among women receiving ART before pregnancy with a mHVL of <50 copies per mL near birth, supporting U=U in pregnancy and birth. Postnatal transmission was very low—but not zero—among women with a recent mHVL of <50 copies per mL. Current data, largely from studies lacking frequent mHVL monitoring or modern first-line ART regimens, are insufficient to assess U=U during breastfeeding.

DOI: 10.1016/S0140-6736(25)00765-2

Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)00765-2/abstract