Stephenson J M, Griffioen A
Department of Sexually Transmitted Disease, University College London Medical School, Mortimer Market Centre, UK.
AIDS. 1996 Dec;10(14):1683-7.
To compare rates of reproductive events before and after HIV diagnosis in a cohort of women with HIV infection, and to consider the impact of HIV diagnosis on the outcome of pregnancy.
Observational cohort study of 503 women recruited from 15 genitourinary medicine/HIV clinics in Britain and Ireland. The 503 women had 580 pregnancies before diagnosis of HIV infection and 202 after HIV diagnosis.
Using date of birth, date of HIV diagnosis, the outcome of all lifetime pregnancies and date of each outcome, age-specific rates (per 100 women-years) of pregnancy, miscarriage, termination and live-birth were calculated before HIV diagnosis, and separately after HIV diagnosis. Rates after HIV diagnosis were age-standardized for comparison with rates before HIV diagnosis. Rates were also calculated separately by ethnic group and HIV transmission group.
In women aged 20-34 years, the age-adjusted live-birth rate fell by 44% from 10.2 [95% confidence interval (CI), 9.2-11.2] per 100 women-years before HIV diagnosis to 5.7 (95% CI, 4.3-7.1) after diagnosis. Most of the decline reflected an increase in termination rate from 3.5 (95% CI, 2.9-4.1) before HIV diagnosis to 6.3 (95% CI, 4.7-7.9) after diagnosis. A decline in live-births together with a rise in termination after HIV diagnosis was a consistent finding across age and ethnic groups. However, black African women had the smallest reduction in live-births, despite the greatest increase in termination, because the pregnancy rate increased after HIV diagnosis in this group.
Diagnosis of HIV infection in women has a substantial impact in reducing live-birth rates. These findings have important implications for expanding HIV testing in women. They highlight the need for better understanding of reproductive decision-making in the context of HIV infection and better contraceptive support for HIV-infected women and their partners.
比较感染HIV的女性队列在HIV诊断前后的生殖事件发生率，并探讨HIV诊断对妊娠结局的影响。
对从英国和爱尔兰15家泌尿生殖医学/HIV诊所招募的503名女性进行观察性队列研究。这503名女性在HIV感染诊断前有580次妊娠，诊断后有202次妊娠。
利用出生日期、HIV诊断日期、所有终身妊娠的结局以及每个结局的日期，计算HIV诊断前以及诊断后按年龄分层的妊娠、流产、终止妊娠和活产发生率（每100名女性年）。HIV诊断后的发生率按年龄标准化，以便与诊断前的发生率进行比较。还按种族和HIV传播组分别计算发生率。
在20 - 34岁的女性中，年龄调整后的活产率从HIV诊断前每100名女性年10.2（95%置信区间[CI]，9.2 - 11.2）下降了44%，至诊断后5.7（95%CI，4.3 - 7.1）。下降的大部分原因是终止妊娠率从HIV诊断前的3.5（95%CI，2.9 - 4.1）上升至诊断后的6.3（95%CI，4.7 - 7.9）。HIV诊断后活产率下降以及终止妊娠率上升在各年龄组和种族中均一致存在。然而，尽管终止妊娠率上升幅度最大，但非洲裔黑人女性的活产率下降幅度最小，因为该组HIV诊断后的妊娠率有所上升。
女性HIV感染诊断对降低活产率有重大影响。这些发现对扩大女性HIV检测具有重要意义。它们凸显了在HIV感染背景下更好地理解生殖决策以及为感染HIV的女性及其伴侣提供更好的避孕支持的必要性。
