Morrison Charles S, Wang Jing, Van Der Pol Barbara, Padian Nancy, Salata Robert A, Richardson Barbra A
Clinical Research Department, Family Health International, Research Triangle Park, North Carolina 27709, USA.
AIDS. 2007 May 11;21(8):1027-34. doi: 10.1097/QAD.0b013e3280f00fc4.
Several studies have suggested that pregnancy is associated with an increased risk of HIV-1 acquisition. We used data from a large, prospective study of hormonal contraception and HIV-1 to evaluate the effect of pregnancy on the risk of HIV-1 acquisition.
A multicenter prospective cohort study.
We examined 4439 women from family planning sites in Uganda and Zimbabwe contributing 31 369 follow-up visits during 1999-2004. Participants were aged 18-35 years, and had received pregnancy and HIV-1 testing quarterly for 15-24 months. Using proportional hazards modeling, we compared the time to HIV-1 acquisition among four groups: pregnant women, non-pregnant lactating (NP/L) women, and women neither pregnant nor lactating (NP/NL) who were either using or not using hormonal contraception.
A total of 211 participants became HIV-1 infected (2.7 per 100 woman-years; wy), including 13 pregnant women (1.6 per 100 wy), 33 NP/L women (2.7 per 100 wy), 126 NP/NL women using hormonal contraception (2.9 per 100 wy), and 39 NP/NL women not using hormonal contraception (2.7 per 100 wy). In multivariable analysis adjusting for site, age, living with partner, risky sexual behaviors, and incident vaginal, cervical and herpes simplex virus 2 infections, neither pregnant, NP/L, nor NP/NL women using hormonal contraception were at an increased risk of HIV-1 acquisition compared with NP/NL women not using hormonal contraception.
Neither pregnancy nor lactation placed women at increased risk of HIV-1 acquisition in this multisite, prospective study of African women. This information is important in planning interventions to reduce HIV-1 acquisition among women.
多项研究表明，怀孕与感染HIV-1的风险增加有关。我们利用一项关于激素避孕与HIV-1的大型前瞻性研究的数据，评估怀孕对感染HIV-1风险的影响。
多中心前瞻性队列研究。
我们对来自乌干达和津巴布韦计划生育机构的4439名女性进行了研究，在1999年至2004年期间进行了31369次随访。参与者年龄在18至35岁之间，每季度接受一次怀孕和HIV-1检测，为期15至24个月。我们使用比例风险模型，比较了四组人群感染HIV-1的时间：孕妇、非怀孕哺乳期（NP/L）女性、使用或未使用激素避孕的非怀孕非哺乳期（NP/NL）女性。
共有211名参与者感染了HIV-1（每100女性年2.7例），其中包括13名孕妇（每100女性年1.6例）、33名NP/L女性（每100女性年2.7例）、126名使用激素避孕的NP/NL女性（每100女性年2.9例）和39名未使用激素避孕的NP/NL女性（每100女性年2.7例）。在对地点、年龄、与伴侣同住、危险性行为以及阴道、宫颈和单纯疱疹病毒2型感染进行多变量分析调整后，与未使用激素避孕的NP/NL女性相比，怀孕、NP/L或使用激素避孕的NP/NL女性感染HIV-1的风险均未增加。
在这项针对非洲女性的多地点前瞻性研究中，怀孕和哺乳均未使女性感染HIV-1的风险增加。这一信息对于规划减少女性感染HIV-1的干预措施具有重要意义。
