Incidence and predictors of pregnancy among a cohort of HIV-positive women initiating antiretroviral therapy in Mbarara, Uganda.
Incidence and predictors of pregnancy among a cohort of HIV-positive women initiating antiretroviral therapy in Mbarara, Uganda.
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DOI：
10.1371/journal.pone.0063411
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发表时间：
2013
期刊：
影响因子：
3.7
通讯作者：
Bangsberg DR
中科院分区：
文献类型：
--
作者：
Kaida A;Matthews LT;Kanters S;Kabakyenga J;Muzoora C;Mocello AR;Martin JN;Hunt P;Haberer J;Hogg RS;Bangsberg DR
撒哈拉以南非洲地区的许多艾滋病毒感染者都渴望亲生孩子。实施艾滋病毒预防战略，支持艾滋病毒感染者的生殖目标，同时最大限度地减少性伴侣和未来孩子的艾滋病毒传播风险，需要全面了解该人群的怀孕情况。我们分析了前瞻性队列数据，以确定在 HIV 患病率和生育率较高的环境中开始抗逆转录病毒治疗 (ART) 的 HIV 阳性女性的妊娠率和预测因素。参与者被纳入乌干达艾滋病农村治疗成果 (UARTO) 队列，该队列由在姆巴拉拉开始抗逆转录病毒治疗的艾滋病毒阳性个体组成。在基线和季度完成血液检查（包括 CD4 细胞/mm3、HIV 病毒载量）和调查问卷（包括社会人口统计、健康状况、性行为、伴侣动态、HIV 病史和自我报告的怀孕）。我们的分析包括 2005 年至 2011 年期间登记的 351 名 HIV 阳性女性（18-49 岁）。我们通过相对于 ART 启动的近端和远端时间测量妊娠发生率，并使用多变量 Cox 比例风险回归分析（重复事件）来确定 ART 启动后妊娠的基线和时间依赖性预测因素。基线时（ART 开始前），中位年龄为 33 岁 [IQR：27-37]，之前活产中位为 4 次 [IQR：2-6]。 38% 已婚，其中 61% 的配偶报告艾滋病毒呈阳性。 73% 的女性向主要性伴侣透露了艾滋病毒感染状况。中位基线 CD4 为 137 个细胞/mm3 [IQR：81–207]。入组时，9.1% (31/342) 报告当前怀孕。开始 ART 后，84 名女性在中位随访 3.8 年期间经历了 105 次怀孕，怀孕发生率为每 100 个周年 9.40 例。 ART开始三年后，至少一次怀孕的累积概率为28%，并且与年轻年龄独立相关（调整后风险比（AHR）：0.89/年增加；95%CI：0.86-0.92）和向主要性伴侣披露HIV血清状况（AHR：2.45；95%CI：1.29-4.63）。近三分之一的妇女在开始抗逆转录病毒治疗后三年内怀孕，这凸显了需要综合服务来预防意外怀孕，并减少选择怀孕的艾滋病毒感染妇女的围孕期相关风险。与年轻年龄和信息披露的关联表明早期和基于夫妇的更安全受孕咨询的作用。
Many people living with HIV in sub-Saharan Africa desire biological children. Implementation of HIV prevention strategies that support the reproductive goals of people living with HIV while minimizing HIV transmission risk to sexual partners and future children requires a comprehensive understanding of pregnancy in this population. We analyzed prospective cohort data to determine pregnancy incidence and predictors among HIV-positive women initiating antiretroviral therapy (ART) in a setting with high HIV prevalence and fertility. Participants were enrolled in the Uganda AIDS Rural Treatment Outcomes (UARTO) cohort of HIV-positive individuals initiating ART in Mbarara. Bloodwork (including CD4 cells/mm3, HIV viral load) and questionnaires (including socio-demographics, health status, sexual behavior, partner dynamics, HIV history, and self-reported pregnancy) were completed at baseline and quarterly. Our analysis includes 351 HIV-positive women (18–49 years) who enrolled between 2005–2011. We measured pregnancy incidence by proximal and distal time relative to ART initiation and used multivariable Cox proportional hazards regression analysis (with repeated events) to identify baseline and time-dependent predictors of pregnancy post-ART initiation. At baseline (pre-ART initiation), median age was 33 years [IQR: 27–37] and median prior livebirths was four [IQR: 2–6]. 38% were married with 61% reporting HIV-positive spouses. 73% of women had disclosed HIV status to a primary sexual partner. Median baseline CD4 was 137 cells/mm3 [IQR: 81–207]. At enrolment, 9.1% (31/342) reported current pregnancy. After ART initiation, 84 women experienced 105 pregnancies over 3.8 median years of follow-up, yielding a pregnancy incidence of 9.40 per 100 WYs. Three years post-ART initiation, cumulative probability of at least one pregnancy was 28% and independently associated with younger age (Adjusted Hazard Ratio (AHR): 0.89/year increase; 95%CI: 0.86–0.92) and HIV serostatus disclosure to primary sexual partner (AHR: 2.45; 95%CI: 1.29–4.63). Nearly one-third of women became pregnant within three years of initiating ART, highlighting the need for integrated services to prevent unintended pregnancies and reduce periconception-related risks for HIV-infected women choosing to conceive. Association with younger age and disclosure suggests a role for early and couples-based safer conception counselling.
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影响因子：
6.8
作者：
AKAIKE, H
通讯作者：
AKAIKE, H
DOI：
10.1056/nejmoa1108524
发表时间：
2012-08-02
期刊：
The New England journal of medicine
影响因子：
--
作者：
Baeten JM;Donnell D;Ndase P;Mugo NR;Campbell JD;Wangisi J;Tappero JW;Bukusi EA;Cohen CR;Katabira E;Ronald A;Tumwesigye E;Were E;Fife KH;Kiarie J;Farquhar C;John-Stewart G;Kakia A;Odoyo J;Mucunguzi A;Nakku-Joloba E;Twesigye R;Ngure K;Apaka C;Tamooh H;Gabona F;Mujugira A;Panteleeff D;Thomas KK;Kidoguchi L;Krows M;Revall J;Morrison S;Haugen H;Emmanuel-Ogier M;Ondrejcek L;Coombs RW;Frenkel L;Hendrix C;Bumpus NN;Bangsberg D;Haberer JE;Stevens WS;Lingappa JR;Celum C;Partners PrEP Study Team
通讯作者：
Partners PrEP Study Team
影响因子：
4.5
作者：
Beyeza-Kashesya J;Ekstrom AM;Kaharuza F;Mirembe F;Neema S;Kulane A
通讯作者：
Kulane A
影响因子：
3.8
作者：
Bujan, Louis;Hollander, Lital;Semprini, Augusto E.
通讯作者：
Semprini, Augusto E.
影响因子：
15.8
作者：
Auvert B;Taljaard D;Lagarde E;Sobngwi-Tambekou J;Sitta R;Puren A
通讯作者：
Puren A