Incident HIV during pregnancy and early postpartum period: a population-based cohort study in a rural area in KwaZulu-Natal, South Africa
Abstract Background The evidence on the effect of pregnancy on acquiring HIV is conflicting, with studies reporting both higher and lower HIV acquisition risk during pregnancy when prolonged antiretroviral therapy was accessible. The aim of this study was to assess the pregnancy effect on HIV acquis...
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doaj-fffba311bb234a9dbc99e588b4a9c7df2020-11-24T20:55:16ZengBMCBMC Pregnancy and Childbirth1471-23932017-07-0117111010.1186/s12884-017-1421-6Incident HIV during pregnancy and early postpartum period: a population-based cohort study in a rural area in KwaZulu-Natal, South AfricaTerusha Chetty0Alain Vandormael1Claire Thorne2Anna Coutsoudis3Africa Health Research InstituteAfrica Health Research InstituteUCL Great Ormond Street Institute of Child Health, University College LondonDepartment of Paediatrics and Child Health, University of KwaZulu-NatalAbstract Background The evidence on the effect of pregnancy on acquiring HIV is conflicting, with studies reporting both higher and lower HIV acquisition risk during pregnancy when prolonged antiretroviral therapy was accessible. The aim of this study was to assess the pregnancy effect on HIV acquisition where antiretroviral therapy was widely available in a high HIV prevalence setting. Methods This is a retrospective cohort study nested within a population-based surveillance to determine HIV incidence in HIV-uninfected women from 15 to 49 years from 2010 through 2015 in rural KwaZulu-Natal. HIV incidence per 100 person-years according to pregnancy status (not pregnant, pregnant, to eight weeks postpartum) were measured in 5260 HIV-uninfected women. Hazard ratios (HR) were estimated by Cox proportional hazards regression with pregnancy included as a time varying variable. Results Overall, pregnancy HIV incidence was 4.5 per 100 person-years (95% CI 3.4–5.8), higher than non-pregnancy (4.0; 95% CI 3.7–4.3) and postpartum incidences (4.2 per 100 person-years; 95% CI 2.3–7.6). However, adjusting for age, and demographic factors, pregnant women had a lower risk of acquiring HIV (HR 0.4; 95% CI 0.2–0.9, P = 0.032) than non-pregnant women; there were no differences between postpartum and non-pregnant women (HR 1.2; 95% CI 0.4–3.2; P = 0.744). In models adjusting for the interaction of age and gravidity, pregnant women under 25 years with two or more pregnancies had a 2.3 times greater risk of acquiring HIV than their older counterparts (95% CI 1.3–4.3; P = 0.008). Conclusions Pregnancy had a protective effect on HIV acquisition. Elevated HIV incidence in younger women appeared to be driven by those with higher gravidity. The sexual and biological factors in younger women should be explored further in order to design appropriate HIV prevention interventions.http://link.springer.com/article/10.1186/s12884-017-1421-6PregnancyPostpartumHIV incidenceSeroconversionAdolescents |
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DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Terusha Chetty Alain Vandormael Claire Thorne Anna Coutsoudis |
spellingShingle |
Terusha Chetty Alain Vandormael Claire Thorne Anna Coutsoudis Incident HIV during pregnancy and early postpartum period: a population-based cohort study in a rural area in KwaZulu-Natal, South Africa BMC Pregnancy and Childbirth Pregnancy Postpartum HIV incidence Seroconversion Adolescents |
author_facet |
Terusha Chetty Alain Vandormael Claire Thorne Anna Coutsoudis |
author_sort |
Terusha Chetty |
title |
Incident HIV during pregnancy and early postpartum period: a population-based cohort study in a rural area in KwaZulu-Natal, South Africa |
title_short |
Incident HIV during pregnancy and early postpartum period: a population-based cohort study in a rural area in KwaZulu-Natal, South Africa |
title_full |
Incident HIV during pregnancy and early postpartum period: a population-based cohort study in a rural area in KwaZulu-Natal, South Africa |
title_fullStr |
Incident HIV during pregnancy and early postpartum period: a population-based cohort study in a rural area in KwaZulu-Natal, South Africa |
title_full_unstemmed |
Incident HIV during pregnancy and early postpartum period: a population-based cohort study in a rural area in KwaZulu-Natal, South Africa |
title_sort |
incident hiv during pregnancy and early postpartum period: a population-based cohort study in a rural area in kwazulu-natal, south africa |
publisher |
BMC |
series |
BMC Pregnancy and Childbirth |
issn |
1471-2393 |
publishDate |
2017-07-01 |
description |
Abstract Background The evidence on the effect of pregnancy on acquiring HIV is conflicting, with studies reporting both higher and lower HIV acquisition risk during pregnancy when prolonged antiretroviral therapy was accessible. The aim of this study was to assess the pregnancy effect on HIV acquisition where antiretroviral therapy was widely available in a high HIV prevalence setting. Methods This is a retrospective cohort study nested within a population-based surveillance to determine HIV incidence in HIV-uninfected women from 15 to 49 years from 2010 through 2015 in rural KwaZulu-Natal. HIV incidence per 100 person-years according to pregnancy status (not pregnant, pregnant, to eight weeks postpartum) were measured in 5260 HIV-uninfected women. Hazard ratios (HR) were estimated by Cox proportional hazards regression with pregnancy included as a time varying variable. Results Overall, pregnancy HIV incidence was 4.5 per 100 person-years (95% CI 3.4–5.8), higher than non-pregnancy (4.0; 95% CI 3.7–4.3) and postpartum incidences (4.2 per 100 person-years; 95% CI 2.3–7.6). However, adjusting for age, and demographic factors, pregnant women had a lower risk of acquiring HIV (HR 0.4; 95% CI 0.2–0.9, P = 0.032) than non-pregnant women; there were no differences between postpartum and non-pregnant women (HR 1.2; 95% CI 0.4–3.2; P = 0.744). In models adjusting for the interaction of age and gravidity, pregnant women under 25 years with two or more pregnancies had a 2.3 times greater risk of acquiring HIV than their older counterparts (95% CI 1.3–4.3; P = 0.008). Conclusions Pregnancy had a protective effect on HIV acquisition. Elevated HIV incidence in younger women appeared to be driven by those with higher gravidity. The sexual and biological factors in younger women should be explored further in order to design appropriate HIV prevention interventions. |
topic |
Pregnancy Postpartum HIV incidence Seroconversion Adolescents |
url |
http://link.springer.com/article/10.1186/s12884-017-1421-6 |
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