Centre for Infectious Diseases Epidemiology & Research, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa.
PLoS Med. 2010 Feb 9;7(2):e1000229. doi: 10.1371/journal.pmed.1000229.
With the rapid expansion of antiretroviral therapy (ART) services in sub-Saharan Africa there is growing recognition of the importance of fertility and childbearing among HIV-infected women. However there are few data on whether ART initiation influences pregnancy rates.
We analyzed data from the Mother-to-Child Transmission-Plus (MTCT-Plus) Initiative, a multicountry HIV care and treatment program for women, children, and families. From 11 programs in seven African countries, women were enrolled into care regardless of HIV disease stage and followed at regular intervals; ART was initiated according to national guidelines on the basis of immunological and/or clinical criteria. Standardized forms were used to collect sociodemographic and clinical data, including incident pregnancies. Overall 589 incident pregnancies were observed among the 4,531 women included in this analysis (pregnancy incidence, 7.8/100 person-years [PY]). The rate of new pregnancies was significantly higher among women receiving ART (9.0/100 PY) compared to women not on ART (6.5/100 PY) (adjusted hazard ratio, 1.74; 95% confidence interval, 1.19-2.54). Other factors independently associated with increased risk of incident pregnancy included younger age, lower educational attainment, being married or cohabiting, having a male partner enrolled into the program, failure to use nonbarrier contraception, and higher CD4 cell counts.
ART use is associated with significantly higher pregnancy rates among HIV-infected women in sub-Saharan Africa. While the possible behavioral or biomedical mechanisms that may underlie this association require further investigation, these data highlight the importance of pregnancy planning and management as a critical but neglected component of HIV care and treatment services. Please see later in the article for the Editors' Summary.
随着抗逆转录病毒疗法（ART）在撒哈拉以南非洲的迅速扩展，人们越来越认识到 HIV 感染者的生育和育儿问题的重要性。然而，关于 ART 启动是否会影响妊娠率的数据却很少。
我们分析了母婴传播 Plus（MTCT-Plus）倡议的数据，该倡议是一个为妇女、儿童和家庭提供艾滋病毒护理和治疗的多国方案。从七个非洲国家的 11 个方案中，无论 HIV 疾病阶段如何，都招募妇女进入护理，并定期进行随访；根据国家免疫和/或临床标准指南，启动 ART。使用标准化表格收集社会人口学和临床数据，包括发生的妊娠。在这项分析中，纳入的 4531 名妇女共观察到 589 例新发妊娠（妊娠发生率为 7.8/100 人年[PY]）。正在接受 ART 治疗的妇女新发妊娠的比率明显高于未接受 ART 治疗的妇女（9.0/100 PY）（校正后的危险比为 1.74；95%置信区间，1.19-2.54）。其他与新发妊娠风险增加相关的因素包括年龄较小、教育程度较低、已婚或同居、男性伴侣参与方案、未能使用非屏障避孕方法以及 CD4 细胞计数较高。
在撒哈拉以南非洲的 HIV 感染者中，使用 ART 与妊娠率显著增加相关。虽然这种关联的可能的行为或生物医学机制需要进一步研究，但这些数据强调了妊娠计划和管理作为 HIV 护理和治疗服务的一个关键但被忽视的组成部分的重要性。请稍后在文章中查看编辑摘要。
