The effect of daily oral PrEP use during pregnancy on bone mineral density among adolescent girls and young women in Uganda.
The effect of daily oral PrEP use during pregnancy on bone mineral density among adolescent girls and young women in Uganda.
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DOI：
10.3389/frph.2023.1240990
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发表时间：
2023
影响因子：
--
通讯作者：
Heffron, Renee
中科院分区：
文献类型：
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作者：
Zewdie, Kidist;Kiweewa, Flavia M;Ssebuliba, Timothy;Morrison, Susan A;Muwonge, Timothy R;Boyer, Jade;Bambia, Felix;Badaru, Josephine;Stein, Gabrielle;Mugwanya, Kenneth K;Wyatt, Christina;Yin, Michael T;Mujugira, Andrew;Heffron, Renee
口服暴露前预防（PrEP）是建议在怀孕期间的风险顺性女性。众所周知，怀孕会阻碍骨骼生长，基于替诺福韦的PrEP也可能对骨骼健康产生有害的变化。因此，我们评估了怀孕期间使用PrEP对骨密度（BMD）的影响。我们使用的数据来自一组性活跃、HIV阴性、年龄16-25岁、开始使用DMPA或选择避孕套避孕并参加坎帕拉妇女骨骼研究的妇女。每季度对妇女进行一次艾滋病毒和妊娠快速检测，PrEP分配和依从性咨询。那些怀孕的人在怀孕期间根据国家指南接受了PrEP使用的咨询。在基线和每年使用双能X线骨密度仪测量髋关节颈部、全髋关节和腰椎的BMD。我们比较了BMD从基线到第24个月的平均百分比变化。在参加研究的499名妇女中，90名妇女发生了105例妊娠。入组时，中位年龄为20岁（IQR：19-21），89%的患者开始使用PrEP。在妊娠期间，67%的女性继续使用PrEP，64%的患者接受了PrEP治疗。与未怀孕或未使用PrEP的女性相比，怀孕期间使用PrEP的女性的BMD显著下降：相对BMD变化为-2.26%（95% CI：−4.63至0.11，p = 0.06）股骨颈，−2.57%（95% CI：−4.48至−0.66，p = 0.01）全髋关节，−3.06%（95% CI：−5.49至−0.63，p = 0.001）腰椎。当比较暴露于PrEP的孕妇与从未使用PrEP的孕妇时，BMD损失没有显著差异。怀孕的妇女在随后的研究访视中继续使用PrEP的可能性低于未怀孕的妇女（adjOR：0.25，95% CI：0.16-0.37，p < 0.001）。根据药丸数量，怀孕期间高PrEP依从性的几率降低了62%（adjOR = 0.38，95%CI：0.27-0.58，p < 0.001）。在怀孕期间使用PrEP的女性与没有暴露于PrEP的孕妇的BMD降低相似，这表明使用PrEP的孕妇的BMD损失主要是由怀孕而不是PrEP驱动的。
Oral pre-exposure prophylaxis (PrEP) is recommended during pregnancy for at-risk cisgender women. Pregnancy is known to impede bone growth and tenofovir-based PrEP may also yield detrimental changes to bone health. Thus, we evaluated the effect of PrEP use during pregnancy on bone mineral density (BMD). We used data from a cohort of women who were sexually active, HIV-negative, ages 16–25 years, initiating DMPA or choosing condoms for contraception and enrolled in the Kampala Women's Bone Study. Women were followed quarterly with rapid testing for HIV and pregnancy, PrEP dispensation, and adherence counseling. Those who became pregnant were counseled on PrEP use during pregnancy per national guidelines. BMD of the neck of the hip, total hip, and lumbar spine was measured using dual-energy x-ray absorptiometry at baseline and annually. We compared the mean percent change in BMD from baseline to month 24. Among 499 women enrolled in the study, 105 pregnancies occurred in 90 women. At enrollment, the median age was 20 years (IQR: 19–21) and 89% initiated PrEP. During pregnancy, 67% of women continued using PrEP and PrEP was dispensed in 64% of visits. BMD declined significantly in women using PrEP during pregnancy compared to women who were not pregnant nor used PrEP: relative BMD change was −2.26% (95% CI: −4.63 to 0.11, p = 0.06) in the femoral neck, −2.57% (95% CI: −4.48 to −0.66, p = 0.01) in total hip, −3.06% (95% CI: −5.49 to −0.63, p = 0.001) lumbar spine. There was no significant difference in BMD loss when comparing PrEP-exposed pregnant women to pregnant women who never used PrEP. Women who became pregnant were less likely to continue PrEP at subsequent study visits than women who did not become pregnant (adjOR: 0.25, 95% CI: 0.16–0.37, p < 0.001). Based on pill counts, there was a 62% reduction in the odds of high PrEP adherence during pregnancy (adjOR = 0.38, 95% CI: 0.27–0.58, p < 0.001). Women who used PrEP during pregnancy experienced a similar reduction in BMD as pregnant women with no PrEP exposure, indicating that BMD loss in PrEP-using pregnant women is largely driven by pregnancy and not PrEP.
影响因子：
3.7
作者：
Kasonde M;Niska RW;Rose C;Henderson FL;Segolodi TM;Turner K;Smith DK;Thigpen MC;Paxton LA
通讯作者：
Paxton LA
影响因子：
4.4
作者：
Moran A;Mashele N;Mvududu R;Gorbach P;Bekker LG;Coates TJ;Myer L;Joseph Davey D
通讯作者：
Joseph Davey D
以客户为中心的依从性咨询和依从性测量反馈，以支持 MTN-025 中达匹维林环的使用（HOPE 研究）。
影响因子：
4.4
作者：
Balán IC;Giguere R;Lentz C;Kutner BA;Kajura-Manyindo C;Byogero R;Asiimwe FB;Makala Y;Jambaya J;Khanyile N;Chetty D;Soto-Torres L;Mayo A;Mgodi NM;Palanee-Phillips T;Baeten JM
通讯作者：
Baeten JM