Increased risk of HIV-1 transmission in pregnancy: a prospective study among African HIV-1-serodiscordant couples.
Increased risk of HIV-1 transmission in pregnancy: a prospective study among African HIV-1-serodiscordant couples.
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DOI：
10.1097/qad.0b013e32834a9338
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发表时间：
2011-09-24
期刊：
影响因子：
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通讯作者：
Partners in Prevention HSV/HIV Transmission Study Team
中科院分区：
文献类型：
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作者：
Mugo NR;Heffron R;Donnell D;Wald A;Were EO;Rees H;Celum C;Kiarie JN;Cohen CR;Kayintekore K;Baeten JM;Partners in Prevention HSV/HIV Transmission Study Team
怀孕期间的生理和行为变化可能会改变HIV-1的易感性和传染性。探索女性怀孕和HIV-1感染风险的前瞻性研究发现了不一致的结果。还没有研究探讨怀孕对艾滋病毒-1从感染艾滋病毒的妇女传播给男性伴侣的风险的影响。在一项对非洲HIV-1血清不一致夫妇的前瞻性研究中，我们评估了怀孕与1)女性感染HIV-1和2)HIV-1从女性传播到男性的风险之间的关系。共登记了3321对HIV-1血清不一致夫妇，其中与HIV-1易感女性伴侣1085对(32.7%)，与易感男性伴侣2236对(67.3%)。孕期和非孕期妇女的HIV-1发病率分别为7.35和3.01/100人年(危险比[HR]2.34，95%可信区间[CI]1.33-4.09)。在调整了性行为和其他混杂因素后，这种影响减弱了，并且没有统计学意义(调整后的HR为1.71，95%CI为0.93-3.12)。感染妇女的男性伴侣中HIV-1感染率为3.46/100人年，而怀孕时为1.58/100人年(HR为2.31，95%CI为1.22~4.39)。在校正分析中，这种影响没有减弱(校正后的HR为2.47，95%可信区间为1.26-4.85)。HIV-1的风险在怀孕期间增加了两倍。孕妇感染HIV-1的风险增加似乎部分是由行为和其他因素造成的。这是首次研究表明怀孕会增加女性向男性传播HIV-1的风险，这可能反映了怀孕的生物变化可能会增加HIV-1的传染性。
Physiologic and behavioral changes during pregnancy may alter HIV-1 susceptibility and infectiousness. Prospective studies exploring pregnancy and HIV-1 acquisition risk in women have found inconsistent results. No study has explored the effect of pregnancy on HIV-1 transmission risk from HIV-1 infected women to male partners. In a prospective study of African HIV-1 serodiscordant couples, we evaluated the relationship between pregnancy and the risk of 1) HIV-1 acquisition among women and 2) HIV-1 transmission from women to men. 3321 HIV-1 serodiscordant couples were enrolled, 1085 (32.7%) with HIV-1 susceptible female partners and 2236 (67.3%) with susceptible male partners. HIV-1 incidence in women was 7.35 versus 3.01 per 100 person-years during pregnant and non-pregnant periods (hazard ratio [HR] 2.34, 95% confidence interval [CI] 1.33–4.09). This effect was attenuated and not statistically significant after adjusting for sexual behavior and other confounding factors (adjusted HR 1.71, 95% CI 0.93–3.12). HIV-1 incidence in male partners of infected women was 3.46 versus 1.58 per 100 person-years when their partners were pregnant versus not pregnant (HR 2.31, 95% CI 1.22–4.39). This effect was not attenuated in adjusted analysis (adjusted HR 2.47, 95% CI 1.26–4.85). HIV-1 risk increased two-fold during pregnancy. Elevated risk of HIV-1 acquisition in pregnant women appeared in part to be explained by behavioral and other factors. This is the first study to show pregnancy increased the risk of female-to-male HIV-1 transmission, which may reflect biological changes of pregnancy that could increase HIV-1 infectiousness.