Incident HIV during pregnancy and early postpartum period: a population-based cohort study in a rural area in KwaZulu-Natal, South Africa
Incident HIV during pregnancy and early postpartum period: a population-based cohort study in a rural area in KwaZulu-Natal, South Africa
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DOI：
10.1186/s12884-017-1421-6
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发表时间：
2017-07-26
影响因子：
3.1
通讯作者：
Coutsoudis, Anna
中科院分区：
文献类型：
--
作者：
Chetty, Terusha;Vandormael, Alain;Coutsoudis, Anna
背景：关于怀孕对感染艾滋病毒的影响的证据是相互矛盾的，有研究报告说，当长期抗逆转录病毒治疗可以获得时，怀孕期间感染艾滋病毒的风险有高有低。本研究的目的是评估在艾滋病毒高流行环境中抗逆转录病毒治疗广泛可用的情况下妊娠对艾滋病毒感染的影响。方法：这是一项基于人群监测的回顾性队列研究，旨在确定2010年至2015年夸祖鲁-纳塔尔省农村15至49岁未感染艾滋病毒的妇女的艾滋病毒发病率。在5260名未感染艾滋病毒的妇女中，根据怀孕状况（未怀孕、怀孕至产后8周）测量了每100人年的艾滋病毒发病率。以妊娠为时变变量，采用Cox比例风险回归法估计风险比（HR）。结果：总体而言，妊娠期HIV感染率为4.5 / 100人年（95% CI 3.4-5.8），高于非妊娠期（4.0 / 100人年，95% CI 3.7-4.3）和产后感染率（4.2 / 100人年，95% CI 2.3-7.6）。然而，调整年龄和人口因素后，孕妇感染艾滋病毒的风险低于非孕妇（HR 0.4; 95% CI 0.2-0.9, P = 0.032）；产后和非孕妇之间无差异（HR 1.2; 95% CI 0.4-3.2; P = 0.744）。在调整年龄和妊娠相互作用的模型中，25岁以下怀孕两次或两次以上的孕妇感染艾滋病毒的风险是年龄较大的孕妇的2.3倍（95% CI 1.3-4.3; P = 0.008）。结论：妊娠对HIV感染有保护作用。年轻女性中艾滋病毒发病率的升高似乎是由那些较高的孕妇引起的。应进一步探讨年轻妇女的性和生物学因素，以便设计适当的艾滋病毒预防干预措施。
Background: The evidence on the effect of pregnancy on acquiring HIV is conflicting, with studies reporting both higher and lower HIV acquisition risk during pregnancy when prolonged antiretroviral therapy was accessible. The aim of this study was to assess the pregnancy effect on HIV acquisition where antiretroviral therapy was widely available in a high HIV prevalence setting.Methods: This is a retrospective cohort study nested within a population-based surveillance to determine HIV incidence in HIV-uninfected women from 15 to 49 years from 2010 through 2015 in rural KwaZulu-Natal. HIV incidence per 100 person-years according to pregnancy status (not pregnant, pregnant, to eight weeks postpartum) were measured in 5260 HIV-uninfected women. Hazard ratios (HR) were estimated by Cox proportional hazards regression with pregnancy included as a time varying variable.Results: Overall, pregnancy HIV incidence was 4.5 per 100 person-years (95% CI 3.4-5.8), higher than non-pregnancy (4.0; 95% CI 3.7-4.3) and postpartum incidences (4.2 per 100 person-years; 95% CI 2.3-7.6). However, adjusting for age, and demographic factors, pregnant women had a lower risk of acquiring HIV (HR 0.4; 95% CI 0.2-0.9, P = 0.032) than non-pregnant women; there were no differences between postpartum and non-pregnant women (HR 1.2; 95% CI 0.4-3.2; P = 0.744). In models adjusting for the interaction of age and gravidity, pregnant women under 25 years with two or more pregnancies had a 2.3 times greater risk of acquiring HIV than their older counterparts (95% CI 1.3-4.3; P = 0.008).Conclusions: Pregnancy had a protective effect on HIV acquisition. Elevated HIV incidence in younger women appeared to be driven by those with higher gravidity. The sexual and biological factors in younger women should be explored further in order to design appropriate HIV prevention interventions.