Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China.
The First Affiliated Hospital of USTC, Hefei, Anhui, China.
PLoS One. 2021 Mar 18;16(3):e0248872. doi: 10.1371/journal.pone.0248872. eCollection 2021.
The fertility desire of people living with HIV (PLHIV) has been rising in the past decade. However, there are many studies among which the association remains controversial between the fertility desire of HIV-infected persons and antiretroviral therapy (ART), sex, marital status, and educational level.
We performed a literature search of these meta-analyses in PubMed, the Cochrane Library, Web of Science and ScienceDirect in November 2019. We also reviewed references of eligible studies to complement the search. We used pooled odds ratios (ORs) and 95% confidence intervals (CIs) with a random-effects model and a fixed-effects model to estimate the association between fertility desire among PLHIV and ART, sex, age, marital status, educational level, and number of children. Subgroups with I square values (I2) and sensitivity analyses were performed to assess the heterogeneity and the stability of the overall ORs, respectively. We evaluated publication bias using Egger's test and a visual inspection of the symmetry in funnel plots.
In these meta-analyses 50 articles were included with 22,367 subjects. The pooled prevalence of fertility desire among PLHIV was estimated to be 42.04%. The pooled analyses showed that the fertility desire of PLHIV is associated with ART (OR = 1.11, 95% CI:1.00-1.23, P = 0.043), sex (OR = 1.51, 95% CI:1.10-2.09), age (OR = 2.65, 95% CI:2.24-3.14), marital status (OR = 1.34, 95% CI:1.08-1.66), educational level (OR = 0.85, 95% CI:0.73-1.00, P = 0.047) and the number of children (OR = 3.99, 95% CI:3.06-5.20). PLHIV who are on ART, are male, are younger than 30, are married/cohabiting, have received a secondary education or above, and are childless have a higher prevalence of fertility desire. The two factors of age and the number of children, in particular demonstrated a strong significant association with fertility desire. We found moderate heterogeneity in the meta-analyses of age and educational level and high heterogeneity in the meta-analyses of sex, marital status and number of children. Publication bias was detected in the meta-analyses of the association of fertility with sex and educational level.
This study demonstrates that the prevalence of fertility desire among HIV-infected people is 42.04%, and the fertility desire among PLHIV is associated with ART experience, sex, age, marital status, the number of children, and educational level. Since a majority of PLHIV are of reproductive age, it is necessary to support PLHIV in terms of their needs regarding reproductive decision-making. Through counseling and reproductive health care, further measures to prevent the horizontal and vertical transmission of HIV should be taken.
在过去的十年中，艾滋病毒感染者（PLHIV）的生育意愿不断上升。然而，许多研究表明，HIV 感染者的生育意愿与抗逆转录病毒治疗（ART）、性别、婚姻状况和教育水平之间的关联仍存在争议。
我们于 2019 年 11 月在 PubMed、Cochrane 图书馆、Web of Science 和 ScienceDirect 中对这些荟萃分析进行了文献检索，并查阅了合格研究的参考文献以补充检索。我们使用合并的优势比（OR）和 95%置信区间（CI），采用随机效应模型和固定效应模型，估计 PLHIV 的生育意愿与 ART、性别、年龄、婚姻状况、教育水平和子女数量之间的关系。使用 I 平方值（I2）和敏感性分析进行亚组分析，分别评估总体 OR 的异质性和稳定性。我们使用 Egger 检验和漏斗图的对称性直观评估发表偏倚。
这些荟萃分析共纳入 50 篇文章，涉及 22367 名受试者。估计 PLHIV 的生育意愿总体流行率为 42.04%。合并分析显示，PLHIV 的生育意愿与 ART（OR=1.11，95%CI：1.00-1.23，P=0.043）、性别（OR=1.51，95%CI：1.10-2.09）、年龄（OR=2.65，95%CI：2.24-3.14）、婚姻状况（OR=1.34，95%CI：1.08-1.66）、教育水平（OR=0.85，95%CI：0.73-1.00，P=0.047）和子女数量（OR=3.99，95%CI：3.06-5.20）有关。正在接受 ART 治疗、男性、年龄小于 30 岁、已婚/同居、接受过中等或高等教育、无子女的 PLHIV 更有可能有生育意愿。年龄和子女数量这两个因素与生育意愿有很强的显著关联。我们在年龄的荟萃分析中发现了中度异质性，在性别的荟萃分析中发现了高度异质性，在婚姻状况和子女数量的荟萃分析中发现了高度异质性。在生育意愿与性别和教育水平的关联的荟萃分析中检测到发表偏倚。
本研究表明，HIV 感染者的生育意愿流行率为 42.04%，PLHIV 的生育意愿与 ART 体验、性别、年龄、婚姻状况、子女数量和教育水平有关。由于大多数 PLHIV 处于生育年龄，因此有必要满足他们在生殖决策方面的需求。通过咨询和生殖保健，应进一步采取措施预防 HIV 的水平和垂直传播。
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