Tenofovir use and pregnancy among women initiating HAART.
Tenofovir use and pregnancy among women initiating HAART.
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开始 HAART 的女性中替诺福韦的使用和怀孕。
DOI：
10.1097/qad.0b013e328359a95c
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发表时间：
2012
期刊：
影响因子：
--
通讯作者：
Sanne,Ian
中科院分区：
文献类型：
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作者：
Maskew,Mhairi;Westreich,Daniel;Firnhaber,Cindy;Sanne,Ian
目的：最近的研究引起了对暴露于替诺福韦的hiv阴性妇女怀孕率变化的关注。在这里，我们的目的是确定hiv阳性妇女在HAART开始或之后使用替诺福韦是否与随后怀孕发生率的变化有关。设计：分析前瞻性收集的临床资料。方法：我们使用Cox比例风险模型和logistic回归来估计基线使用替诺福韦与首次妊娠相关的风险比和优势比。我们使用边际结构Cox模型来估计当前替诺福韦使用与首次怀孕时间之间的关联风险比。结果：我们研究了7275名妇女，其中1199名开始使用以替诺福韦为基础的HAART方案，在17200人年的随访中，共有894名妇女怀孕。分析显示，使用替诺福韦的妇女怀孕风险略有降低，但没有足够的准确性来得出强有力的结论。敏感性分析证实了主要结果。结论：替诺福韦可能与接受HAART治疗的妇女妊娠风险或发生率较低有关。然而，结论受到精度低、数据的观察性、避孕使用的时间趋势和其他因素可能造成的不受控制的混淆等因素的限制。
Objective:Recent studies have raised concerns about a change in rates of pregnancy among HIV-negative women exposed to tenofovir. Here, our objective was to determine among HIV-positive women whether use of tenofovir at HAART initiation or thereafter is associated with subsequent changes in incidence of pregnancy.Design:Analysis of prospectively collected clinical data.Methods:We used Cox proportional hazards models and logistic regression to estimate hazard ratios and odds ratios for the association of baseline tenofovir use and first incident pregnancy. We used marginal structural Cox models to estimate hazard ratios for the association of current tenofovir use and time to first incident pregnancy.Results:We studied 7275 women, of whom 1199 were initiated on tenofovir-based HAART regimens, and who experienced a total of 894 pregnancies in 17 200 person-years of follow-up. Analyses showed slight reductions in hazards of pregnancy among women who used tenofovir but without sufficient precision to draw strong conclusions. Sensitivity analyses confirmed main results.Conclusions:Tenofovir may be associated with a lower hazard or rate of pregnancy in women receiving HAART. However, conclusions are limited by low precision, the observational nature of the data, and possible uncontrolled confounding by temporal trends in contraception use and other factors.