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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

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
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 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.
1932-6203
1-9
Marston, M.
e805459e-71c2-4e04-9927-10794820169d
Newell, M.L.
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Crampin, M.
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Lutalo, T.
64f94f83-cfdd-47c7-ac30-5b6750144335
Musoke, R.
659c9cba-4b01-4b4b-a18a-6ceaba4ee94d
Gregson, S.
b80454d4-7348-4413-8ef3-ceb698eb7a68
Nyamukapa, C.
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Nakiyingi-Miiro, J.
2392f913-ef6d-467f-90f4-5f4ea73aa1e8
Urassa, M.
0455eac5-59f3-4cd7-91a8-94b42f6b3ccb
Isingo, R.
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Zaba, B.
e6c30ee3-64fb-4d0f-8602-599ff1e79043
Marston, M.
e805459e-71c2-4e04-9927-10794820169d
Newell, M.L.
c6ff99dd-c23b-4fef-a846-a221fe2522b3
Crampin, M.
18696a21-e94f-4d55-8323-6f4fd22baa04
Lutalo, T.
64f94f83-cfdd-47c7-ac30-5b6750144335
Musoke, R.
659c9cba-4b01-4b4b-a18a-6ceaba4ee94d
Gregson, S.
b80454d4-7348-4413-8ef3-ceb698eb7a68
Nyamukapa, C.
19ac0d35-0c9e-4126-96f5-7d57c13ec48a
Nakiyingi-Miiro, J.
2392f913-ef6d-467f-90f4-5f4ea73aa1e8
Urassa, M.
0455eac5-59f3-4cd7-91a8-94b42f6b3ccb
Isingo, R.
4d22a81b-044e-4dd5-8a13-038c73229260
Zaba, B.
e6c30ee3-64fb-4d0f-8602-599ff1e79043

Marston, M., Newell, M.L., Crampin, M., Lutalo, T., Musoke, R., Gregson, S., Nyamukapa, C., Nakiyingi-Miiro, J., Urassa, M., Isingo, R. and Zaba, B. (2013) 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. PLoS ONE, 8 (12), 1-9. (doi:10.1371/journal.pone.0082219). (PMID:24386091)

Record type: Article

Abstract

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.

Text
Marston, Newell et al Pregnancy and HIV risk from Alphanet in PLoS One 2013.pdf - Version of Record
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More information

Accepted/In Press date: 24 October 2013
Published date: 26 December 2013
Organisations: Faculty of Medicine

Identifiers

Local EPrints ID: 379570
URI: http://eprints.soton.ac.uk/id/eprint/379570
ISSN: 1932-6203
PURE UUID: e30c448e-d9e8-443d-8e92-e23014ad1c00
ORCID for M.L. Newell: ORCID iD orcid.org/0000-0002-1074-7699

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Date deposited: 10 Aug 2015 16:09
Last modified: 07 Oct 2020 02:04

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Contributors

Author: M. Marston
Author: M.L. Newell ORCID iD
Author: M. Crampin
Author: T. Lutalo
Author: R. Musoke
Author: S. Gregson
Author: C. Nyamukapa
Author: J. Nakiyingi-Miiro
Author: M. Urassa
Author: R. Isingo
Author: B. Zaba

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