Predictors of pregnancy and changes in pregnancy incidence among HIV-positive women accessing HIV clinical care.
OBJECTIVE
To describe predictors of pregnancy and changes in pregnancy incidence among HIV-positive women accessing HIV clinical care.


METHODS
Data were obtained through the linkage of two separate studies: the UK Collaborative HIV Cohort study (UK CHIC), a cohort of adults attending 13 large HIV clinics; and the National Study of HIV in Pregnancy and Childhood (NSHPC), a national surveillance study of HIV-positive pregnant women. Pregnancy incidence was measured using the proportion of women in UK CHIC with a pregnancy reported to NSHPC. Generalized estimating equations were used to identify predictors of pregnancy and assess changes in pregnancy incidence in 2000-2009.


RESULTS
The number of women accessing care at UK CHIC sites increased as did the number of pregnancies. Older women were less likely to have a pregnancy [adjusted relative rate (aRR) 0.44 per 10 year increment in age, [95% confidence interval (CI) (0.41-0.46)], P < 0.001] as were women with CD4 cell count less than 200 cells/μl compared with CD4 cell count 200-350 cells/μl [aRR 0.65 (0.55-0.77), P < 0.001] and women of white ethnicity compared with women of black African ethnicity [aRR 0.67 (0.57-0.80), P < 0.001]. The likelihood that women had a pregnancy increased over the study period [aRR 1.05 (1.03-1.07), P < 0.001). The rate of change did not significantly differ according to age group, antiretroviral therapy use, CD4 group or ethnicity.


CONCLUSIONS
The pregnancy rate among women accessing HIV clinical care increased in 2000-2009. HIV-positive women with, or planning, a pregnancy require a high level of care and this is likely to continue and increase as more women of older age have pregnancies.
Medical Research Council (MRC) Centre of Epidemiology for Child Health, Institute of Child Health, University College London, London, UK. susan.huntington.09@ucl.ac.uk
Susie E
SE
Huntington
Claire
C
Thorne
Loveleen K
LK
Bansi
Jane
J
Anderson
Marie-Louise
ML
Newell
Graham P
GP
Taylor
Deenan
D
Pillay
Teresa
T
Hill
Pat A
PA
Tookey
Caroline A
CA
Sabin
D000293:Adolescent; D000328:Adult; D000368:Aged; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D005260:Female; D006679:HIV Seropositivity / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control / Q000706:statistics & numerical data*; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology* / Q000517:prevention & control; D011295:Prenatal Care / Q000706:statistics & numerical data*; D043762:Reproductive Behavior / Q000706:statistics & numerical data*; D018571:Sentinel Surveillance; D013997:Time Factors; D006113:United Kingdom / Q000453:epidemiology