在整个孕期和产后期间，女性 HIV 感染风险增加：一项针对 HIV 感染伴侣的女性每一次性行为分析的前瞻性研究。
Increased Risk of HIV Acquisition Among Women Throughout Pregnancy and During the Postpartum Period: A Prospective Per-Coital-Act Analysis Among Women With HIV-Infected Partners.
机构信息
Department of Epidemiology, University of Washington, Seattle.
Department of Biostatistics, University of Washington, Seattle.
出版信息
J Infect Dis. 2018 Jun 5;218(1):16-25. doi: 10.1093/infdis/jiy113.
BACKGROUND
Understanding the absolute and relative risk of human immunodeficiency virus type 1 (HIV) acquisition during pregnancy and the postpartum period can inform HIV prevention strategies for women.
METHODS
We used a complementary log-log model and data from 2751 HIV-serodiscordant couples to compare the probability of HIV acquisition among women per sex act during early pregnancy, late pregnancy, the postpartum period, and the nonpregnant period.
RESULTS
At total of 686 pregnancies were identified, and 82 incident HIV infections occurred. After adjustment for condom use, age, preexposure prophylaxis (PrEP) use, and HIV viral load, the per-act probability of HIV acquisition was higher in late pregnancy (adjusted relative risk [aRR], 2.82; P = .01) and the postpartum period (aRR, 3.97; P = .01) as compared to that during nonpregnant period. For a 25-year-old woman not taking PrEP, the HIV acquisition probability per condomless sex act with an HIV-infected male partner with a viral load of 10 000 copies/mL was 0.0011 (95% confidence interval [CI] 0.005-0.0019), 0.0022 (95% CI, 0.0004-0.0093), 0.0030 (95% CI, 0.0007-0.0108), and 0.0042 (95% CI, 0.0007-0.0177) during the nonpregnant period, early pregnancy, late pregnancy, and the postpartum period, respectively.
CONCLUSION
The HIV acquisition probability per condomless sex act steadily increased during pregnancy and was highest during the postpartum period, suggesting that biological changes during pregnancy and the postpartum period increase HIV susceptibility among women.
背景
了解人类免疫缺陷病毒 1 型（HIV）在妊娠和产后期间的绝对和相对风险，可以为女性的 HIV 预防策略提供信息。
方法
我们使用互补对数-对数模型和来自 2751 对 HIV 血清不一致的夫妇的数据，比较了在妊娠早期、妊娠晚期、产后和非孕期期间，每次性行为中女性感染 HIV 的概率。
结果
共确定了 686 例妊娠，发生了 82 例 HIV 感染事件。在调整了避孕套使用、年龄、暴露前预防（PrEP）使用和 HIV 病毒载量后，与非孕期相比，妊娠晚期（调整后的相对风险 [aRR]，2.82；P =.01）和产后期间（aRR，3.97；P =.01）每次性行为感染 HIV 的概率更高。对于未服用 PrEP 的 25 岁女性，与 HIV 病毒载量为 10000 拷贝/毫升的 HIV 感染男性伴侣无保护性行为时，感染 HIV 的概率分别为 0.0011（95%置信区间 [CI]，0.005-0.0019）、0.0022（95% CI，0.0004-0.0093）、0.0030（95% CI，0.0007-0.0108）和 0.0042（95% CI，0.0007-0.0177）在非孕期、妊娠早期、妊娠晚期和产后期间。
结论
每次无保护性行为感染 HIV 的概率在妊娠期间稳步增加，在产后期间最高，这表明妊娠和产后期间的生物学变化增加了女性感染 HIV 的易感性。
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