Gray R H, Wawer M J, Serwadda D, Sewankambo N, Li C, Wabwire-Mangen F, Paxton L, Kiwanuka N, Kigozi G, Konde-Lule J, Quinn T C, Gaydos C A, McNairn D
Department of Population Dynamics, School of Hygiene and Public Health, Johns Hopkins University, Baltimore MD 21205, USA.
Lancet. 1998 Jan 10;351(9096):98-103. doi: 10.1016/S0140-6736(97)09381-1.
To assess the effects of HIV-1 and other sexually transmitted infections on pregnancy, we undertook cross-sectional and prospective studies of a rural population in Rakai district, Uganda.
4813 sexually active women aged 15-49 years were surveyed to find out the prevalence of pregnancy by interview and selective urinary human chorionic gonadotropin tests. The incidence of recognised conception and frequency of pregnancy loss were assessed by follow-up. Samples were taken to test for HIV-1 infection, syphilis, and other sexually transmitted diseases.
At time of survey 757 (21.4%) of 3544 women without HIV-1 infection or syphilis were pregnant, compared with 46 (14.6%) of 316 HIV-1-negative women with active syphilis, 117 (14.2%) of 823 HIV-1-positive women with no concurrent syphilis, and 11 (8.5%) of 130 women with both syphilis and HIV-1 infection. The multivariate adjusted odds ratio of pregnancy in HIV-1-infected women was 0.45 (95% CI 0.35-0.57); the odds of pregnancy were low both in HIV-1-infected women without symptoms (0.49 [0.39-0.62]) and in women with symptoms of HIV-1-associated disease (0.23 [0.11-0.48]). In women with concurrent HIV-1 infection and syphilis the odds ratio was 0.28 (0.14-0.55). The incidence rate of recognised pregnancy during the prospective follow-up study was lower in HIV-1-positive than in HIV-1-negative women (23.5 vs 30.1 per 100 woman-years; adjusted risk ratio 0.73 [0.57-0.93]). Rates of pregnancy loss were higher among HIV-1-infected than uninfected women (18.5 vs 12.2%; odds ratio 1.50 [1.01-2.27]). The prevalence of HIV-1 infection was significantly lower in pregnant than in non-pregnant women (13.9 vs 21.3%).
Pregnancy prevalence is greatly reduced in HIV-1-infected women, owing to lower rates of conception and increased rates of pregnancy loss. HIV-1 surveillance confined to pregnant women underestimates the magnitude of the HIV-1 epidemic in the general population.
为评估人类免疫缺陷病毒1型（HIV-1）及其他性传播感染对妊娠的影响，我们在乌干达拉凯区的农村人口中开展了横断面研究和前瞻性研究。
对4813名年龄在15至49岁之间有性活动的女性进行调查，通过访谈和选择性尿人绒毛膜促性腺激素检测来了解妊娠患病率。通过随访评估已确认妊娠的发生率和流产频率。采集样本检测HIV-1感染、梅毒及其他性传播疾病。
在调查时，3544名未感染HIV-1或梅毒的女性中有757名（21.4%）怀孕，相比之下，316名患有活动性梅毒的HIV-1阴性女性中有46名（14.6%）怀孕，823名未并发梅毒的HIV-1阳性女性中有117名（14.2%）怀孕，130名同时感染梅毒和HIV-1的女性中有11名（8.5%）怀孕。HIV-1感染女性妊娠的多变量调整比值比为0.45（95%置信区间0.35 - 0.57）；无症状的HIV-1感染女性（0.49 [0.39 - 0.62]）和有HIV-1相关疾病症状的女性（0.23 [0.11 - 0.48]）妊娠几率均较低。同时感染HIV-1和梅毒的女性的比值比为0.28（0.14 - 0.55）。在前瞻性随访研究期间，HIV-1阳性女性中已确认妊娠的发生率低于HIV-1阴性女性（每100妇女年分别为23.5例和30.1例；调整风险比0.73 [0.57 - 0.93]）。HIV-1感染女性的流产率高于未感染女性（18.5%对12.2%；比值比1.50 [1.01 - 2.27]）。HIV-1感染的患病率在孕妇中显著低于非孕妇（13.9%对21.3%）。
由于受孕率降低和流产率增加，HIV-1感染女性的妊娠患病率大幅降低。仅针对孕妇的HIV-1监测会低估普通人群中HIV-1流行的规模。
