在乌干达农村地区，与艾滋病毒感染者生活在一起的男性中，有意伴侣怀孕的发生率很高：对更安全的受孕服务的影响。
High Incidence of Intended Partner Pregnancy Among Men Living With HIV in Rural Uganda: Implications for Safer Conception Services.
机构信息
Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada.
Faculty of Medicine, Mbarara University of Science and Technology (MUST), Mbarara, Uganda.
出版信息
J Acquir Immune Defic Syndr. 2019 Aug 15;81(5):497-507. doi: 10.1097/QAI.0000000000002053.
BACKGROUND
Many men with HIV express fertility intentions and nearly half have HIV-uninfected sexual partners. We measured partner pregnancy among a cohort of men accessing antiretroviral therapy in Uganda.
METHODS
Self-reported partner pregnancy incidence and bloodwork (CD4, HIV-RNA) were collected quarterly. Interviewer-administered questionnaires assessed men's sexual and reproductive health annually and repeated at time of reported pregnancy (2011-2015). We measured partner pregnancy incidence overall, by pregnancy intention and by reported partner HIV serostatus. We assessed viral suppression (≤400 copies/mL) during the periconception period. Cox proportional hazard regression with repeated events identified predictors of partner pregnancy.
RESULTS
Among 189 men, the baseline median age was 39.9 years (interquartile range: 34.7-47.0), years on antiretroviral therapy was 3.9 (interquartile range: 0.0-5.1), and 51% were virally suppressed. Over 530.2 person-years of follow-up, 63 men reported 85 partner pregnancies (incidence = 16.0/100 person-years); 45% with HIV-serodifferent partners. By 3 years of follow-up, 30% of men reported a partner pregnancy, with no difference by partner HIV serostatus (P = 0.75). Sixty-nine percent of pregnancies were intended, 18% wanted but mistimed, and 8% unwanted. Seventy-eight percent of men were virally suppressed before pregnancy report. Men who were younger [adjusted hazard ratio (aHR): 0.94/yr; 95% confidence interval (CI): 0.89 to 0.99], had incomplete primary education (aHR: 2.95; 95% CI: 1.36 to 6.40), and reported fertility desires (aHR: 2.25; 95% CI: 1.04 to 4.85) had higher probability of partner pregnancy.
CONCLUSIONS
A high incidence of intended partner pregnancy highlights the need to address men's reproductive goals within HIV care. Nearly half of pregnancy partners were at-risk for HIV, and one-quarter of men were not virally suppressed during periconception. Safer conception care provides opportunity to support men's health and reproductive goals, while preventing HIV transmission to women and infants.
背景
许多感染 HIV 的男性表达了生育意愿，近一半的男性有 HIV 阴性的性伴侣。我们在乌干达的一组接受抗逆转录病毒治疗的男性中测量了伴侣怀孕的情况。
方法
每季度收集自我报告的伴侣怀孕发生率和血液检查（CD4、HIV-RNA）数据。每年通过访谈者管理的问卷评估男性的性健康和生殖健康，并在报告怀孕时（2011-2015 年）重复评估。我们总体上测量了伴侣怀孕的发生率，按怀孕意图和报告的伴侣 HIV 血清状态进行测量。我们评估了围孕期的病毒抑制情况（≤400 拷贝/mL）。重复事件的 Cox 比例风险回归确定了伴侣怀孕的预测因素。
结果
在 189 名男性中，基线中位年龄为 39.9 岁（四分位距：34.7-47.0），接受抗逆转录病毒治疗的年限为 3.9 年（四分位距：0.0-5.1），51%的男性病毒得到抑制。在超过 530.2 人年的随访中，63 名男性报告了 85 例伴侣怀孕（发生率=16.0/100 人年）；45%的伴侣 HIV 血清学不同。在 3 年的随访中，30%的男性报告了伴侣怀孕，伴侣 HIV 血清状态没有差异（P=0.75）。69%的怀孕是有意的，18%是有意但时机不对，8%是无意的。78%的男性在报告怀孕前病毒得到抑制。年龄较小的男性（调整后的危险比[aHR]：0.94/年；95%置信区间[CI]：0.89 至 0.99）、未完成小学教育的男性（aHR：2.95；95%CI：1.36 至 6.40）和报告生育愿望的男性（aHR：2.25；95%CI：1.04 至 4.85），更有可能发生伴侣怀孕。
结论
高比例的有意伴侣怀孕突显了在 HIV 护理中需要解决男性的生殖目标。近一半的怀孕伴侣存在 HIV 感染风险，四分之一的男性在围孕期未得到病毒抑制。更安全的受孕护理提供了支持男性健康和生殖目标的机会，同时预防了 HIV 向女性和婴儿的传播。
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