Increased Risk of HIV-1 Transmission in Pregnancy: A Prospective Study among African HIV-1-Serodiscordant Couples
Mugo, N. R., Heffron, R., Donnell, D., et al. AIDS (2011), 25(15), pp. 1887–1895.
This secondary data analysis study explored how pregnancy in serodiscordant couples affected HIV-1 acquisition in women and HIV-1 transmission from women to men. Data from 3,321 African couples in seven countries who were enrolled in the Partners in Prevention HSV/HIV Transmission Study, a study that tested the effect of acyclovir herpes simplex virus type 2 suppressive therapy for the prevention of HIV transmission, was utilized. Multivariate Cox proportional hazard analysis was performed to control for any demographic, clinical, or behavioral factors. During the study period, 151 individuals seroconverted (with 61 infections occurring among women and 90 occurring among men) and there were a total of 823 pregnancies. Couples who became pregnant were younger and more likely to report unprotected sex during pregnancy. About 28 percent of women who HIV-1 seroconverted during the study were pregnant. The incidence of HIV-1 during pregnancy was 7.35 per 100 person-years compared to 3.01 per 100 person-years during nonpregnancy, but was not found to be statistically significant in multivariate analysis. About 21 percent of men who HIV-1 seroconverted during the study period did so while their partner was pregnant. The incidence of female-to-male HIV-1 transmission was 3.46 per 100 person-years during pregnancy compared to 1.58 per 100 person-years when the partner was not pregnant, and was statistically significant after multivariate analysis. In conclusion, there is an increased risk of HIV acquisition among HIV-negative women and increased risk of HIV transmission to men during pregnancy, which calls for more emphasis on risk reduction counseling, family planning, and early initiation of antiretroviral therapy during pregnancy among discordant couples.