Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH, USA.
Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
HIV Med. 2022 Apr;23(4):406-416. doi: 10.1111/hiv.13171. Epub 2021 Sep 12.
To evaluate the associations of HIV infection with preterm birth (PTB), and of HIV antiretroviral therapy (ART) with PTB.
We analysed singleton live-born pregnancies among women from 1995 to 2019 in the Women's Interagency HIV Study, a prospective cohort of US women with, or at risk for, HIV. The primary exposures were HIV status and ART use before delivery [none, monotherapy or dual therapy, or highly active antiretroviral therapy (HAART)]. The primary outcome was PTB < 34 weeks, and, secondarily, < 28 and < 37 weeks. We analysed self-reported birth data, and separately modelled the associations between HIV and PTB, and between ART and PTB, among women with HIV. We used modified Poisson regression, and adjusted for age, race, parity, tobacco use and delivery year, and, when modelling the impact of ART, duration from HIV diagnosis to delivery, nadir CD4 count, and pre-pregnancy viral load and CD4 count.
We analysed 488 singleton deliveries (56% exposed to HIV) to 383 women. The risk of PTB < 34 weeks was similar among women with and without HIV, but the risk of PTB < 37 weeks was higher [32% vs. 23%; adjusted risk ratio (aRR) = 1.43; 95% confidence interval (CI): 1.07-1.91] among women with HIV. The risk of PTB < 34 weeks was lower among women with HIV receiving HAART than among those receiving no ART (7% vs. 26%; aRR:0.19; 95% CI: 0.08-0.44). The associations between HAART and PTB < 28 and < 37 weeks were similar.
Antiretroviral therapy exposure was associated with a decreased risk of PTB among a US cohort of women with HIV. Given the growing concerns about ART and adverse pregnancy outcomes, this finding that ART may be protective for PTB is reassuring.
评估 HIV 感染与早产（PTB）的关系，以及 HIV 抗逆转录病毒治疗（ART）与 PTB 的关系。
我们分析了 1995 年至 2019 年期间在美国妇女机构间 HIV 研究（一项针对有或有 HIV 风险的美国妇女的前瞻性队列研究）中，单胎活产妊娠。主要暴露因素为分娩前的 HIV 状态和 ART 使用情况（无、单药治疗或双药治疗或高效抗逆转录病毒治疗（HAART））。主要结局是 <34 周的早产，其次是 <28 周和 <37 周的早产。我们分析了自我报告的分娩数据，并分别对 HIV 与 PTB 之间以及 ART 与 PTB 之间的关系进行了建模，这些模型是针对 HIV 妇女进行的。我们使用修正后的泊松回归，并根据年龄、种族、产次、吸烟和分娩年份进行了调整，在对 ART 影响进行建模时，还根据从 HIV 诊断到分娩的时间、最低 CD4 计数以及孕前病毒载量和 CD4 计数进行了调整。
我们分析了 383 名 HIV 妇女的 488 例单胎分娩（56%暴露于 HIV）。有 HIV 的妇女与无 HIV 的妇女相比，PTB <34 周的风险相似，但有 HIV 的妇女 PTB <37 周的风险更高（32% vs. 23%；调整后的风险比（aRR）=1.43；95%置信区间（CI）：1.07-1.91）。与未接受 ART 的妇女相比，接受 HAART 的 HIV 妇女 PTB <34 周的风险较低（7% vs. 26%；aRR：0.19；95%CI：0.08-0.44）。HAART 与 PTB <28 周和 <37 周的关联相似。
抗逆转录病毒治疗的暴露与美国 HIV 妇女队列中 PTB 风险的降低有关。鉴于人们对 ART 和不良妊娠结局的担忧日益增加，ART 可能对 PTB 有保护作用的这一发现令人欣慰。
