Pregnancy and the risk of HIV-1 acquisition among women in Uganda and Zimbabwe.
OBJECTIVE
Several studies have suggested that pregnancy is associated with an increased risk of HIV-1 acquisition. We used data from a large, prospective study of hormonal contraception and HIV-1 to evaluate the effect of pregnancy on the risk of HIV-1 acquisition.


METHODS
A multicenter prospective cohort study.


METHODS
We examined 4439 women from family planning sites in Uganda and Zimbabwe contributing 31 369 follow-up visits during 1999-2004. Participants were aged 18-35 years, and had received pregnancy and HIV-1 testing quarterly for 15-24 months. Using proportional hazards modeling, we compared the time to HIV-1 acquisition among four groups: pregnant women, non-pregnant lactating (NP/L) women, and women neither pregnant nor lactating (NP/NL) who were either using or not using hormonal contraception.


RESULTS
A total of 211 participants became HIV-1 infected (2.7 per 100 woman-years; wy), including 13 pregnant women (1.6 per 100 wy), 33 NP/L women (2.7 per 100 wy), 126 NP/NL women using hormonal contraception (2.9 per 100 wy), and 39 NP/NL women not using hormonal contraception (2.7 per 100 wy). In multivariable analysis adjusting for site, age, living with partner, risky sexual behaviors, and incident vaginal, cervical and herpes simplex virus 2 infections, neither pregnant, NP/L, nor NP/NL women using hormonal contraception were at an increased risk of HIV-1 acquisition compared with NP/NL women not using hormonal contraception.


CONCLUSIONS
Neither pregnancy nor lactation placed women at increased risk of HIV-1 acquisition in this multisite, prospective study of African women. This information is important in planning interventions to reduce HIV-1 acquisition among women.
Morrison
Charles S
CS
Clinical Research Department, Family Health International, Research Triangle Park, North Carolina 27709, USA. cmorrison@fhi.org
Wang
Jing
J
Van Der Pol
Barbara
B
Padian
Nancy
N
Salata
Robert A
RA
Richardson
Barbra A
BA
D000293:Adolescent; D000328:Adult; D003268:Contraception Behavior / Q000706:statistics & numerical data; D003278:Contraceptives, Oral, Hormonal / Q000008:administration & dosage; D004812:Epidemiologic Methods; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000635:transmission*; D015497:HIV-1; D006801:Humans; D007774:Lactation; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology*; D012309:Risk-Taking; D012725:Sexual Behavior / Q000706:statistics & numerical data; D014454:Uganda / Q000453:epidemiology; D015030:Zimbabwe / Q000453:epidemiology
D003278:Contraceptives, Oral, Hormonal