Pregnancy rates and clinical outcomes among women living with HIV enrolled in HPTN 052 - PubMed (original) (raw)

. 2023 Jun;35(6):824-832.

doi: 10.1080/09540121.2022.2141187. Epub 2022 Dec 16.

Sahar Z Zangeneh 1 2 3, Surabhi Ahluwalia 2, Deborah J Donnell 2 3, Ying Q Chen 4, Beatriz Grinsztejn 5, Marineide G Melo 6, Sheela V Godbole 7, Mina C Hosseinipour 8 9, Taha Taha 10, Johnston Kumwenda 11, Marybeth McCauley 12, Myron S Cohen 8, Karin Nielsen-Saines 13

Affiliations

Pregnancy rates and clinical outcomes among women living with HIV enrolled in HPTN 052

Sahar Z Zangeneh et al. AIDS Care. 2023 Jun.

Abstract

HPTN 052 was a multi-country clinical trial of cART for preventing heterosexual HIV-1 transmission. The study allowed participation of pregnant women and provided access to cART and contraceptives. We explored associations between pregnancy and clinical measures of HIV disease stage and progression. Of 869 women followed for 5.70 (SD = 1.62) years, 94.7% were married/cohabitating, 96% initiated cART, and 76.3% had >2 past pregnancies. Of 337 women who experienced pregnancy, 89.3% were from countries with lower contraceptive coverage, 56.1% first started cART with PI-based regimens and 57.6% were 25-34 years old. Mean cART duration and condom use were similar among pregnant and nonpregnant individuals. Adjusting for confounders, viral load suppression (VLS) was not (aHR(CI) = 0.82(0.61, 1.08)) and CD4 was slightly associated with decreased rates of first pregnancy over time (aHR(CI) = 0.9(0.84, 0.95)); baseline VLS was associated with increased (aRR(CI) = 2.48(1.71, 3.59)) and baseline CD4 was slightly associated with decreased number of pregnancies (aRR(CI) = 0.9(0.85,0.96)) over study duration. Partner seroconversion was univariably associated with higher rates of first pregnancy (HR(CI) = 2.02(1.32,3.07)). Despite a background of higher maternal morbidity and mortality rates, our findings suggest that becoming pregnant does not pose a threat to maternal health in women with HIV when there is access to medical care and antiretroviral treatment.

Keywords: Combination antiretroviral therapy (cART); HIV; contraception; pregnancy; women living with HIV (WLH); women’s health.

PubMed Disclaimer

Figures

Figure 1.

Figure 1.. Cumulative Hazard curves for time to first pregnancy, stratified by CD4 categories and VLS status baseline and distribution of CD4 cell counts and VLS.

Panels A and B depict the Cumulative Hazard curves for time to first pregnancy, stratified by CD4 categories and VLS status baseline. Panel C displays proportion of WEP and WNP who were virally suppressed aggregated over each year. A higher proportion of women became virally suppressed as the study progressed and slightly higher among WNP. Panel D displays boxplots comparing absolute CD4 counts at enrollment and aggregated annually over the first five years of follow-up for WEP and WNP. Lower median levels of absolute CD4 cell counts and more variability was observed for WNP compared to WEP.

Figure 1.

Figure 1.. Cumulative Hazard curves for time to first pregnancy, stratified by CD4 categories and VLS status baseline and distribution of CD4 cell counts and VLS.

Panels A and B depict the Cumulative Hazard curves for time to first pregnancy, stratified by CD4 categories and VLS status baseline. Panel C displays proportion of WEP and WNP who were virally suppressed aggregated over each year. A higher proportion of women became virally suppressed as the study progressed and slightly higher among WNP. Panel D displays boxplots comparing absolute CD4 counts at enrollment and aggregated annually over the first five years of follow-up for WEP and WNP. Lower median levels of absolute CD4 cell counts and more variability was observed for WNP compared to WEP.

Figure 1.

Figure 1.. Cumulative Hazard curves for time to first pregnancy, stratified by CD4 categories and VLS status baseline and distribution of CD4 cell counts and VLS.

Panels A and B depict the Cumulative Hazard curves for time to first pregnancy, stratified by CD4 categories and VLS status baseline. Panel C displays proportion of WEP and WNP who were virally suppressed aggregated over each year. A higher proportion of women became virally suppressed as the study progressed and slightly higher among WNP. Panel D displays boxplots comparing absolute CD4 counts at enrollment and aggregated annually over the first five years of follow-up for WEP and WNP. Lower median levels of absolute CD4 cell counts and more variability was observed for WNP compared to WEP.

References

    1. Allison PD (2010). Survival analysis using SAS: a practical guide: SAS Institute.
    1. Bale JR, Stoll BJ, & Lucas AO (2003). Reducing birth defects: meeting the challenge in the developing world: National Academies Press Washington. -PubMed
    1. Blossfeld H-P (1995). Changes in the process of family formation and women’s growing economic independence: A comparison of nine countries. The new role of women: Family formation in modern societies, 3–32.
    1. Clark DA, & Croitoru K (2001). TH1/TH2, 3 imbalance due to cytokine-producing NK, γδ T and NK-γδ T cells in murine pregnancy decidua in success or failure of pregnancy. American journal of reproductive immunology, 45(5), 257–265. -PubMed
    1. Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour M, Kumarasamy N, . . . Fleming TR (2016). Antiretroviral therapy for the prevention of HIV-1 transmission. New England Journal of Medicine, 830–839. -PMC -PubMed

Publication types

MeSH terms

Substances

Grants and funding

LinkOut - more resources