McLean Estelle, Price Alison, Chihana Menard, Kayuni Ndoliwe, Marston Milly, Koole Olivier, Zaba Basia, Crampin Amelia
*Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom; and†Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi.
J Acquir Immune Defic Syndr. 2017 Aug 1;75(4):391-398. doi: 10.1097/QAI.0000000000001395.
HIV reduces fertility through biological and social pathways, and antiretroviral treatment (ART) can ameliorate these effects. In northern Malawi, ART has been available since 2007 and lifelong ART is offered to all pregnant or breastfeeding HIV-positive women.
Using data from the Karonga Health and Demographic Surveillance Site in Malawi from 2005 to 2014, we used total and age-specific fertility rates and Cox regression to assess associations between HIV and ART use and fertility. We also assessed temporal trends in in utero and breastfeeding HIV and ART exposure among live births.
From 2005 to 2014, there were 13,583 live births during approximately 78,000 person years of follow-up of women aged 15-49 years. The total fertility rate in HIV-negative women decreased from 6.1 [95% confidence interval (CI): 5.5 to 6.8] in 2005-2006 to 5.1 (4.8-5.5) in 2011-2014. In HIV-positive women, the total fertility rate was more stable, although lower, at 4.4 (3.2-6.1) in 2011-2014. In 2011-2014, compared with HIV-negative women, the adjusted (age, marital status, and education) hazard ratio was 0.7 (95% CI: 0.6 to 0.9) and 0.8 (95% CI: 0.6 to 1.0) for women on ART for at least 9 months and not (yet) on ART, respectively. The crude fertility rate increased with duration on ART up to 3 years before declining. The proportion of HIV-exposed infants decreased, but the proportion of ART-exposed infants increased from 2.4% in 2007-2010 to 3.5% in 2011-2014.
Fertility rates in HIV-positive women are stable in the context of generally decreasing fertility. Despite a decrease in HIV-exposed infants, there has been an increase in ART-exposed infants.
艾滋病毒通过生物和社会途径降低生育能力，抗逆转录病毒治疗（ART）可以改善这些影响。在马拉维北部，自2007年以来就有抗逆转录病毒治疗，并且为所有怀孕或哺乳的艾滋病毒阳性妇女提供终身抗逆转录病毒治疗。
利用马拉维卡龙加卫生和人口监测点2005年至2014年的数据，我们使用总和特定年龄生育率以及Cox回归来评估艾滋病毒与抗逆转录病毒治疗的使用和生育能力之间的关联。我们还评估了活产婴儿中子宫内和母乳喂养期间艾滋病毒和抗逆转录病毒治疗暴露的时间趋势。
2005年至2014年期间，在对15至49岁妇女进行的约78,000人年的随访中，有13,583例活产。艾滋病毒阴性妇女的总生育率从2005 - 2006年的6.1 [95%置信区间（CI）：5.5至6.8]降至2011 - 2014年的5.1（4.8 - 5.5）。在艾滋病毒阳性妇女中，总生育率更为稳定，尽管较低，2011 - 2014年为4.4（3.2 - 6.1）。在2011 - 2014年，与艾滋病毒阴性妇女相比，接受抗逆转录病毒治疗至少9个月和未（尚未）接受抗逆转录病毒治疗的妇女经调整（年龄、婚姻状况和教育程度）后的风险比分别为0.7（95% CI：0.6至0.9）和0.8（95% CI：0.6至1.0）。粗生育率在接受抗逆转录病毒治疗3年之前随治疗时间延长而上升，之后下降。艾滋病毒暴露婴儿的比例下降，但抗逆转录病毒治疗暴露婴儿的比例从2007 - 2010年的2.4%上升至2011 - 2014年的3.5%。
在总体生育率下降的背景下，艾滋病毒阳性妇女的生育率保持稳定。尽管艾滋病毒暴露婴儿有所减少，但抗逆转录病毒治疗暴露婴儿有所增加。
