Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
AIDS. 2013 Jun 19;27(10):1631-9. doi: 10.1097/QAD.0b013e32835fd940.
Although much is known about the contribution of HIV to adult mortality, remarkably little is known about the mortality attributable to HIV during pregnancy. In this article we estimate the proportion of pregnancy-related deaths attributable to HIV based on empirical data from a systematic review of the strength of association between HIV and pregnancy-related mortality.
Studies comparing mortality during pregnancy and the postpartum in HIV-infected and HIV-uninfected women were included. Summary estimates of the relative and attributable risks for the association between HIV and pregnancy-related mortality were calculated through meta-analyses. Varying estimates of HIV prevalence were used to predict the impact of the HIV epidemic on pregnancy-related mortality at the population level.
Twenty-three studies were included (17 from sub-Saharan Africa). Meta-analysis of the risk ratios indicated that HIV-infected women had eight times the risk of a pregnancy-related death compared with HIV-uninfected women [pooled risk ratio 7.74, 95% confidence interval (95% CI) 5.37-11.16]. The excess mortality attributable to HIV among HIV-infected pregnant and postpartum women was 994 per 100,000 pregnant women. We predict that 12% of all deaths during pregnancy and up to 1-year postpartum are attributable to HIV/AIDS in regions with a prevalence of HIV among pregnant women of 2%. This figure rises to 50% in regions with a prevalence of 15%.
The substantial excess of pregnancy-related mortality associated with HIV highlights the importance of integrating HIV and reproductive health services in areas of high HIV prevalence and pregnancy-related mortality.
尽管人们对 HIV 对成人死亡率的影响有了很多了解，但对怀孕期间 HIV 导致的死亡率却知之甚少。本文通过对 HIV 与妊娠相关死亡率之间关联的强度进行系统评价，根据实证数据，估计了 HIV 导致的妊娠相关死亡比例。
纳入了比较 HIV 感染者和未感染者在怀孕期间和产后死亡率的研究。通过荟萃分析计算了 HIV 与妊娠相关死亡率之间关联的相对风险和归因风险的汇总估计。使用不同的 HIV 流行率估计值来预测 HIV 流行对人群中妊娠相关死亡率的影响。
共纳入 23 项研究（17 项来自撒哈拉以南非洲地区）。风险比的荟萃分析表明，与未感染 HIV 的女性相比，感染 HIV 的女性妊娠相关死亡的风险高 8 倍[合并风险比 7.74，95%置信区间（95%CI）为 5.37-11.16]。HIV 感染的孕妇和产后妇女归因于 HIV 的超额死亡率为每 10 万孕妇 994 例。我们预测，在 HIV 感染孕妇比例为 2%的地区，所有妊娠期间和产后 1 年内的死亡中有 12%归因于 HIV/AIDS。在 HIV 感染孕妇比例为 15%的地区，这一数字上升到 50%。
与 HIV 相关的妊娠相关死亡率显著增加，这凸显了在 HIV 高流行地区和妊娠相关死亡率高的地区整合 HIV 和生殖健康服务的重要性。
