Burgos-Soto Juan, Balestre Eric, Minga Albert, Ajayi Samuel, Sawadogo Adrien, Zannou Marcel D, Leroy Valériane, Ekouevi Didier K, Dabis François, Becquet Renaud
*Université de Bordeaux, ISPED, Centre INSERM U897-Epidémiologie-Biostatistique, Bordeaux, France; †INSERM, ISPED, Centre INSERM U897-Epidémiologie-Biostatistique, Bordeaux, France; ‡Centre Médical de Suivi de Donneurs de Sang (CMSDS), Abidjan, Côte d'Ivoire; §University of Abuja Teaching Hospital (UATH), Abuja, Nigeria; ‖Hôpital de jour, CHU Souro Sanou, Bobo Dioulasso, Burkina-Faso; ¶Centre de Prise en Charge des Personnes vivant avec le VIH, CHNU, Cotonou, Benin; and #Département des sciences fondamentales et santé publique, faculté des sciences de la santé, université de Lomé, Lomé, Togo.
J Acquir Immune Defic Syndr. 2014 Oct 1;67(2):e45-54. doi: 10.1097/QAI.0000000000000279.
This study aimed at estimating the incidence of pregnancy after antiretroviral therapy (ART) initiation in 8 West African countries over a 10-year period.
A retrospective analysis was conducted within the international database of the IeDEA West Africa Collaboration. All HIV-infected women aged <50 years and starting ART for their own health between 1998 and 2011 were eligible. Pregnancy after ART initiation was the main outcome and was based on clinical reporting. Poisson regression analysis accounting for country heterogeneity was computed to estimate first pregnancy incidence post-ART and to identify its associated factors. Pregnancy incidence rate ratios were adjusted on country, baseline CD4 count and clinical stage, hemoglobin, age, first ART regimen, and calendar year.
Overall, 29,425 HIV-infected women aged 33 years in median (interquartile range, 28-38) contributed for 84,870 women-years of follow-up to this analysis. The crude incidence of first pregnancy (2304 events) was 2.9 per 100 women-years [95% confidence interval (CI): 2.7 to 3.0], the highest rate being reported among women aged 25-29 years: 4.7 per 100 women-years; 95% CI: 4.3 to 5.1. The overall Kaplan-Meier probability of pregnancy occurrence by the fourth year on ART was 10.9% (95% CI: 10.4 to 11.4) and as high as 28.4% (95% CI: 26.3 to 30.6) among women aged 20-29 years at ART initiation.
The rate of pregnancy occurrence after ART initiation among HIV-infected women living in the West Africa region was high. Family planning services tailored to procreation needs should be provided to all HIV-infected women initiating ART and health consequences carefully monitored in this part of the world.
本研究旨在估计10年间8个西非国家开始抗逆转录病毒治疗（ART）后怀孕的发生率。
在IeDEA西非合作组织的国际数据库中进行回顾性分析。所有年龄小于50岁且在1998年至2011年间因自身健康问题开始接受ART治疗的HIV感染女性均符合条件。开始ART治疗后的怀孕情况是主要结局，基于临床报告。采用考虑国家异质性的泊松回归分析来估计ART治疗后首次怀孕的发生率，并确定其相关因素。怀孕发生率比值在国家、基线CD4细胞计数和临床分期、血红蛋白、年龄、初始ART治疗方案以及日历年等方面进行了调整。
总体而言，29425名HIV感染女性（中位年龄33岁，四分位间距28 - 38岁）为该分析贡献了84870人年的随访数据。首次怀孕的粗发生率（2304例事件）为每100名女性年2.9例[95%置信区间（CI）：2.7至3.0]，25 - 29岁女性的发生率最高：每100名女性年4.7例；95% CI：4.3至5.1。ART治疗第4年时怀孕的总体Kaplan - Meier概率为10.9%（95% CI：10.4至11.4），在开始ART治疗时年龄为20 - 29岁的女性中高达28.4%（95% CI：26.3至30.6）。
在西非地区，HIV感染女性开始ART治疗后怀孕的发生率较高。应为所有开始接受ART治疗的HIV感染女性提供符合生育需求的计划生育服务，并在此地区仔细监测其健康后果。
