Wong Jeffrey Man Hay, Av-Gay Gal, Lee Terry, Azampanah Arezou, Elwood Chelsea, van Schalkwyk Julie, Sauvé Laura, Money Deborah
Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada.
Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC, Canada.
Int J STD AIDS. 2025 Aug;36(9):712-718. doi: 10.1177/09564624251347458. Epub 2025 May 30.
BackgroundWhile individual sexually transmitted infections are linked with preterm births, their synergistic impact among pregnant people living with HIV (PLWH) remain unclear. We aimed to identify the impact of antenatal sexually transmitted infections and bacterial vaginosis on preterm birth in PLWH.MethodsWe completed a population-based cohort study using the British Columbia Perinatal HIV Surveillance Database, capturing all births in PLWH from January 1997 to December 2022. Univariate risk factors for preterm birth were identified using chi-squared tests, Fisher's exact tests and t-tests, followed by a multivariate logistic regression analysis.ResultsOf 578 singleton pregnancies, 111 (19.2%) had preterm births, of which 34 (31%) delivered before 34 weeks gestational age. In our population, 11% were identified with a sexually transmitted infection or bacterial vaginosis (STIBV) in pregnancy. The preterm birth rate in PLWH with antenatal STIBV was 37% compared to 17% in PLWH without STIBV (OR: 2.18; 95% CI (1.50 - 3.16); = .0003). Preterm deliveries were more common in individuals with concurrent Hepatitis C (OR: 2.42; < .0001), antenatal diagnosis of (OR 2.17; = .036), (OR: 2.78; < .001) and bacterial vaginosis (OR: 2.15; = .003). After adjusting for ethnicity, history of preterm birth, substance use, concurrent Hepatitis C, CD4 count and viral suppression at delivery, STIBV remains an independent risk factor (OR: 2.09; 95% CI: 1.04 - 4.19; = .039).ConclusionAmong PLWH, antenatal screening for sexually transmitted infections and bacterial vaginosis can identify individuals at the highest risk of preterm birth.
背景
虽然个别性传播感染与早产有关，但它们对感染艾滋病毒的孕妇（PLWH）的协同影响仍不清楚。我们旨在确定产前性传播感染和细菌性阴道病对PLWH早产的影响。
方法
我们使用不列颠哥伦比亚省围产期艾滋病毒监测数据库完成了一项基于人群的队列研究，记录了1997年1月至2022年12月期间PLWH的所有分娩情况。使用卡方检验、费舍尔精确检验和t检验确定早产的单因素风险因素，随后进行多因素逻辑回归分析。
结果
在578例单胎妊娠中，111例（19.2%）发生早产，其中34例（31%）在孕34周前分娩。在我们的研究人群中，11%的孕妇在孕期被诊断为性传播感染或细菌性阴道病（STIBV）。产前患有STIBV的PLWH早产率为37%，而未患有STIBV的PLWH早产率为17%（比值比：2.18；95%置信区间（1.50 - 3.16）；P = 0.0003）。丙型肝炎合并感染的个体（比值比：2.42；P < 0.0001）、产前诊断为梅毒（比值比2.17；P = 0.036）、淋病（比值比：2.78；P < 0.001）和细菌性阴道病（比值比：2.15；P = 0.003）的个体中早产更常见。在调整了种族、早产史、药物使用、丙型肝炎合并感染、CD4细胞计数和分娩时的病毒抑制情况后，STIBV仍然是一个独立的风险因素（比值比：2.09；95%置信区间：1.04 - 4.19；P = 0.039）。
结论
在PLWH中，产前筛查性传播感染和细菌性阴道病可以识别出早产风险最高的个体。
