Effect of HIV Infection and Antiretroviral Treatment on Pregnancy Rates in the Western Cape Province of South Africa
Effect of HIV Infection and Antiretroviral Treatment on Pregnancy Rates in the Western Cape Province of South Africa
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DOI：
10.1093/infdis/jiz362
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发表时间：
2020-06-15
影响因子：
6.4
通讯作者：
Boulle, Andrew
中科院分区：
文献类型：
--
作者：
Johnson, Leigh F.;Mutemaringa, Themba;Boulle, Andrew
背景以往的研究表明，未经治疗的人类免疫缺陷病毒（HIV）感染与妊娠发生率降低有关，但抗逆转录病毒治疗（ART）对妊娠发生率的影响的研究一直不一致。来自南非西开普省卫生服务的常规数据与2007-2017年期间的怀孕和孕产妇艾滋病毒记录相关联。采用考克斯比例风险模型对从第一次（指数）妊娠结局日期到下一次妊娠的时间进行建模。在2007-2017年期间，记录了1，042，647例妊娠。在所有年龄组中，已开始抗逆转录病毒治疗的妇女怀孕率最高，艾滋病毒阴性妇女怀孕率较低，未接受抗逆转录病毒治疗的艾滋病毒阳性妇女怀孕率最低。在多变量分析中，在控制最近的CD 4（+）T细胞计数后，接受ART的HIV阳性妇女的妊娠发生率高于未经治疗的HIV阳性妇女（校正风险比，1.63; 95%置信区间，1.59-1.67）和HIV阴性妇女。在最近怀孕的妇女中，接受抗逆转录病毒疗法与第二次怀孕率高有关。需要更好地将计划生育纳入艾滋病毒护理服务。
Background. Previous studies suggest that untreated human immunodeficiency virus (HIV) infection is associated with a reduced incidence of pregnancy, but studies of the effect of antiretroviral treatment (ART) on pregnancy incidence have been inconsistent.Methods. Routine data from health services in the Western Cape province of South Africa were linked to identify pregnancies during 2007-2017 and maternal HIV records. The time from the first (index) pregnancy outcome date to the next pregnancy was modeled using Cox proportional hazards models.Results. During 2007-2017, 1 042 647 pregnancies were recorded. In all age groups, pregnancy incidence rates were highest in women who had started ART, lower in HIV-negative women, and lowest in ART-naive HIV-positive women. In multivariable analysis, after controlling for the most recent CD4(+) T-cell count, pregnancy incidence rates in HIV-positive women receiving ART were higher than those in untreated HIV-positive women (adjusted hazard ratio, 1.63; 95% confidence interval, 1.59-1.67) and those in HIV-negative women.Conclusion. Among women who have recently been pregnant, receipt of ART is associated with high rates of second pregnancy. Better integration of family planning into HIV care services is needed.