Department of Obstetrics and Gynecology and Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America.
PLoS One. 2013;8(3):e58117. doi: 10.1371/journal.pone.0058117. Epub 2013 Mar 8.
Little is known about the impact of pregnancy on response to highly active antiretroviral therapy (HAART) in sub-Saharan Africa. We examined the effect of incident pregnancy after HAART initiation on clinical response to HAART.
We evaluated a prospective clinical cohort of adult women initiating HAART in Johannesburg, South Africa between 1 April 2004 and 31 March 2011, and followed up until an event, transfer, drop-out, or administrative end of follow-up on 30 September 2011. Women over age 45 and women who were pregnant at HAART initiation were excluded from the study. Main exposure was having experienced pregnancy after HAART initiation; main outcome was death and (separately) death or new AIDS event. We calculated adjusted hazard ratios (HRs) and 95% confidence limits (CL) using marginal structural Cox proportional hazards models.
The study included 7,534 women, and 20,813 person-years of follow-up; 918 women had at least one recognized pregnancy during follow-up. For death alone, the weighted (adjusted) HR was 0.84 (95% CL 0.44, 1.60). Sensitivity analyses confirmed main results, and results were similar for analysis of death or new AIDS event. Incident pregnancy was associated with a substantially reduced hazard of drop-out (HR = 0.62, 95% CL 0.51, 0.75).
Recognized incident pregnancy after HAART initiation was not associated with increases in hazard of clinical events, but was associated with a decreased hazard of drop-out. High rates of pregnancy after initiation of HAART may point to a need to better integrate family planning services into clinical care for HIV-infected women.
在撒哈拉以南非洲，人们对怀孕对高效抗逆转录病毒治疗（HAART）反应的影响知之甚少。我们研究了 HAART 开始后发生的妊娠对 HAART 临床反应的影响。
我们评估了 2004 年 4 月 1 日至 2011 年 3 月 31 日期间在南非约翰内斯堡开始接受 HAART 的成年女性的前瞻性临床队列，并随访至 2011 年 9 月 30 日发生事件、转移、退出或行政随访结束。排除年龄超过 45 岁和 HAART 开始时怀孕的女性。主要暴露是 HAART 开始后经历过妊娠；主要结局是死亡和（分别）死亡或新发艾滋病事件。我们使用边缘结构 Cox 比例风险模型计算调整后的危险比（HR）和 95%置信区间（CL）。
研究包括 7534 名女性和 20813 人年的随访；918 名女性在随访期间至少有一次妊娠被记录。仅死亡的加权（调整）HR 为 0.84（95%CL 0.44，1.60）。敏感性分析证实了主要结果，且分析死亡或新发艾滋病事件的结果也相似。发生妊娠与退出的风险显著降低相关（HR=0.62，95%CL 0.51，0.75）。
HAART 开始后发生的公认妊娠与临床事件的风险增加无关，但与退出的风险降低有关。HAART 开始后妊娠率高可能表明需要更好地将计划生育服务纳入 HIV 感染女性的临床护理中。
