Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa.
Department of Health, Provincial Government of the Western Cape, Cape Town, South Africa.
J Infect Dis. 2020 Jun 11;221(12):1953-1962. doi: 10.1093/infdis/jiz362.
Previous studies suggest that untreated human immunodeficiency virus (HIV) infection is associated with a reduced incidence of pregnancy, but studies of the effect of antiretroviral treatment (ART) on pregnancy incidence have been inconsistent.
Routine data from health services in the Western Cape province of South Africa were linked to identify pregnancies during 2007-2017 and maternal HIV records. The time from the first (index) pregnancy outcome date to the next pregnancy was modeled using Cox proportional hazards models.
During 2007-2017, 1 042 647 pregnancies were recorded. In all age groups, pregnancy incidence rates were highest in women who had started ART, lower in HIV-negative women, and lowest in ART-naive HIV-positive women. In multivariable analysis, after controlling for the most recent CD4+ T-cell count, pregnancy incidence rates in HIV-positive women receiving ART were higher than those in untreated HIV-positive women (adjusted hazard ratio, 1.63; 95% confidence interval, 1.59-1.67) and those in HIV-negative women.
Among women who have recently been pregnant, receipt of ART is associated with high rates of second pregnancy. Better integration of family planning into HIV care services is needed.
既往研究表明，未经治疗的人类免疫缺陷病毒（HIV）感染与妊娠发生率降低相关，但抗逆转录病毒治疗（ART）对妊娠发生率影响的研究结果并不一致。
对南非西开普省卫生服务机构的常规数据进行了关联，以确定 2007 年至 2017 年间的妊娠情况和产妇 HIV 记录。使用 Cox 比例风险模型对首次（索引）妊娠结局日期到下一次妊娠的时间进行建模。
2007 年至 2017 年间，共记录了 1 042 647 例妊娠。在所有年龄组中，开始接受 ART 的女性妊娠发生率最高，HIV 阴性女性妊娠发生率较低，ART 初治 HIV 阳性女性妊娠发生率最低。多变量分析结果显示，在控制了最近的 CD4+ T 细胞计数后，接受 ART 的 HIV 阳性女性的妊娠发生率高于未接受治疗的 HIV 阳性女性（调整后的危险比，1.63；95%置信区间，1.59-1.67）和 HIV 阴性女性。
在最近有过妊娠的女性中，接受 ART 与较高的再次妊娠率相关。需要更好地将计划生育纳入 HIV 护理服务中。
