Department of Obstetrics and Gynecology, Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America.
PLoS One. 2011;6(8):e22778. doi: 10.1371/journal.pone.0022778. Epub 2011 Aug 2.
Although women of reproductive age are the largest group of HIV-infected individuals in sub-Saharan Africa, little is known about the impact of pregnancy on response to highly active antiretroviral therapy (HAART) in that setting. We examined the effect of incident pregnancy after HAART initiation on virologic response to HAART.
We evaluated a prospective clinical cohort of adult women who initiated HAART in Johannesburg, South Africa between 1 April 2004 and 30 September 2009, and followed up until an event, death, transfer, drop-out, or administrative end of follow-up on 31 March 2010. Women over age 45 and women who were pregnant at HAART initiation were excluded from the study; final sample size for analysis was 5,494 women. Main exposure was incident pregnancy, experienced by 541 women; main outcome was virologic failure, defined as a failure to suppress virus to ≤ 400 copies/ml by six months or virologic rebound >400 copies/ml thereafter. We calculated adjusted hazard ratios using marginal structural Cox proportional hazards models and weighted lifetable analysis to calculate adjusted five-year risk differences. The weighted hazard ratio for the effect of pregnancy on time to virologic failure was 1.34 (95% confidence limit [CL] 1.02, 1.78). Sensitivity analyses generally confirmed these main results.
Incident pregnancy after HAART initiation was associated with modest increases in both relative and absolute risks of virologic failure, although uncontrolled confounding cannot be ruled out. Nonetheless, these results reinforce that family planning is an essential part of care for HIV-positive women in sub-Saharan Africa. More work is needed to confirm these findings and to explore specific etiologic pathways by which such effects may operate.
尽管撒哈拉以南非洲的育龄妇女是感染艾滋病毒人数最多的群体，但对于该人群在接受高效抗逆转录病毒治疗（HAART）后怀孕对治疗反应的影响知之甚少。我们研究了 HAART 起始后新发妊娠对 HAART 病毒学反应的影响。
我们评估了在南非约翰内斯堡于 2004 年 4 月 1 日至 2009 年 9 月 30 日期间开始接受 HAART 的成年女性的前瞻性临床队列，并随访至 2010 年 3 月 31 日发生事件、死亡、转移、退出或行政随访结束。排除年龄超过 45 岁和 HAART 起始时怀孕的女性；分析的最终样本量为 5494 名女性。主要暴露为 541 名女性经历的新发妊娠；主要结局是病毒学失败，定义为六个月时未能将病毒抑制到 ≤400 拷贝/ml 或此后病毒学反弹>400 拷贝/ml。我们使用边缘结构 Cox 比例风险模型和加权寿命表分析计算调整后的危险比，以计算调整后的五年风险差异。妊娠对病毒学失败时间的影响的加权危险比为 1.34（95%置信区间[CL]1.02，1.78）。敏感性分析普遍证实了这些主要结果。
HAART 起始后新发妊娠与病毒学失败的相对和绝对风险均适度增加相关，尽管不能排除未控制的混杂因素。尽管如此，这些结果强化了计划生育是撒哈拉以南非洲艾滋病毒阳性妇女护理的重要组成部分。需要做更多的工作来证实这些发现，并探讨可能导致这种影响的具体病因途径。
