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Is the Risk of HIV Acquisition Increased during and Immediately after Pregnancy? A Secondary Analysis of Pooled HIV Community-Based Studies from the ALPHA Network
BACKGROUND: Previous studies of HIV acquisition in pregnancy have been in specific population groups, such as sero-discordant couples which have shown an increased risk of HIV acquisition during pregnancy and studies of sexually active women where the results have been ambiguous. However these studi...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2013
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3873249/ https://www.ncbi.nlm.nih.gov/pubmed/24386091 http://dx.doi.org/10.1371/journal.pone.0082219 |
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author | Marston, Milly Newell, Marie Louise Crampin, Amelia Lutalo, Tom Musoke, Richard Gregson, Simon Nyamukapa, Constance Nakiyingi-Miiro, Jessica Urassa, Mark Isingo, Raphael Zaba, Basia |
author_facet | Marston, Milly Newell, Marie Louise Crampin, Amelia Lutalo, Tom Musoke, Richard Gregson, Simon Nyamukapa, Constance Nakiyingi-Miiro, Jessica Urassa, Mark Isingo, Raphael Zaba, Basia |
author_sort | Marston, Milly |
collection | PubMed |
description | BACKGROUND: Previous studies of HIV acquisition in pregnancy have been in specific population groups, such as sero-discordant couples which have shown an increased risk of HIV acquisition during pregnancy and studies of sexually active women where the results have been ambiguous. However these studies are unable to tell us what the overall impact of pregnancy is on HIV acquisition in the general population. METHODS: Data from six community-based HIV cohorts were pooled to give 2,628 sero-conversions and a total of 178,000 person years of observation. Multiple imputation was used to allow for the uncertainty of exact sero-conversion date in surveillance intervals greater than the length of a pregnancy. Results were combined using Rubin’s rules to give appropriate error bounds. The analysis was stratified into two periods: pre- and post- widespread availability of prevention of mother-to-child HIV transmission services. This allows us to assess whether there is reporting bias relating to a person’s knowledge of their own HIV status which would become more widespread in the latter time period. RESULTS: Results suggest that women while pregnant have a lower risk of acquiring HIV infection over all periods (HRR 0.79, 95%CI 0.70-0.89) than women who were not pregnant. There is no evidence for a difference in the rate of HIV acquisition between postpartum and non-pregnant women (HRR 0.92 95%CI 0.84-1.03). DISCUSSION: Although there may be immunological reasons for increased risk of HIV acquisition during pregnancy, at a population level this study indicates a lower risk of HIV acquisition for pregnant women. Pregnant women may be more likely to be concordant with their current sexual partner than non-pregnant women, i.e. either already HIV positive prior to the pregnancy or if negative at the time of becoming pregnant more likely to have a negative partner. |
format | Online Article Text |
id | pubmed-3873249 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2013 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-38732492014-01-02 Is the Risk of HIV Acquisition Increased during and Immediately after Pregnancy? A Secondary Analysis of Pooled HIV Community-Based Studies from the ALPHA Network Marston, Milly Newell, Marie Louise Crampin, Amelia Lutalo, Tom Musoke, Richard Gregson, Simon Nyamukapa, Constance Nakiyingi-Miiro, Jessica Urassa, Mark Isingo, Raphael Zaba, Basia PLoS One Research Article BACKGROUND: Previous studies of HIV acquisition in pregnancy have been in specific population groups, such as sero-discordant couples which have shown an increased risk of HIV acquisition during pregnancy and studies of sexually active women where the results have been ambiguous. However these studies are unable to tell us what the overall impact of pregnancy is on HIV acquisition in the general population. METHODS: Data from six community-based HIV cohorts were pooled to give 2,628 sero-conversions and a total of 178,000 person years of observation. Multiple imputation was used to allow for the uncertainty of exact sero-conversion date in surveillance intervals greater than the length of a pregnancy. Results were combined using Rubin’s rules to give appropriate error bounds. The analysis was stratified into two periods: pre- and post- widespread availability of prevention of mother-to-child HIV transmission services. This allows us to assess whether there is reporting bias relating to a person’s knowledge of their own HIV status which would become more widespread in the latter time period. RESULTS: Results suggest that women while pregnant have a lower risk of acquiring HIV infection over all periods (HRR 0.79, 95%CI 0.70-0.89) than women who were not pregnant. There is no evidence for a difference in the rate of HIV acquisition between postpartum and non-pregnant women (HRR 0.92 95%CI 0.84-1.03). DISCUSSION: Although there may be immunological reasons for increased risk of HIV acquisition during pregnancy, at a population level this study indicates a lower risk of HIV acquisition for pregnant women. Pregnant women may be more likely to be concordant with their current sexual partner than non-pregnant women, i.e. either already HIV positive prior to the pregnancy or if negative at the time of becoming pregnant more likely to have a negative partner. Public Library of Science 2013-12-26 /pmc/articles/PMC3873249/ /pubmed/24386091 http://dx.doi.org/10.1371/journal.pone.0082219 Text en © 2013 Marston et al http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited. |
spellingShingle | Research Article Marston, Milly Newell, Marie Louise Crampin, Amelia Lutalo, Tom Musoke, Richard Gregson, Simon Nyamukapa, Constance Nakiyingi-Miiro, Jessica Urassa, Mark Isingo, Raphael Zaba, Basia Is the Risk of HIV Acquisition Increased during and Immediately after Pregnancy? A Secondary Analysis of Pooled HIV Community-Based Studies from the ALPHA Network |
title | Is the Risk of HIV Acquisition Increased during and Immediately after Pregnancy? A Secondary Analysis of Pooled HIV Community-Based Studies from the ALPHA Network |
title_full | Is the Risk of HIV Acquisition Increased during and Immediately after Pregnancy? A Secondary Analysis of Pooled HIV Community-Based Studies from the ALPHA Network |
title_fullStr | Is the Risk of HIV Acquisition Increased during and Immediately after Pregnancy? A Secondary Analysis of Pooled HIV Community-Based Studies from the ALPHA Network |
title_full_unstemmed | Is the Risk of HIV Acquisition Increased during and Immediately after Pregnancy? A Secondary Analysis of Pooled HIV Community-Based Studies from the ALPHA Network |
title_short | Is the Risk of HIV Acquisition Increased during and Immediately after Pregnancy? A Secondary Analysis of Pooled HIV Community-Based Studies from the ALPHA Network |
title_sort | is the risk of hiv acquisition increased during and immediately after pregnancy? a secondary analysis of pooled hiv community-based studies from the alpha network |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3873249/ https://www.ncbi.nlm.nih.gov/pubmed/24386091 http://dx.doi.org/10.1371/journal.pone.0082219 |
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