title: 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.
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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Milly
authors.initials: M
authors.lastname: Marston
authors.affiliation: Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Somkhele, South Africa ; Faculty of Medicine, Faculty of Social and Human Sciences, University of Southampton, Southampton, United Kingdom.
authors.forename: Marie Louise
authors.initials: ML
authors.lastname: Newell
authors.affiliation: Karonga Prevention Study, Chilumba, Malawi ; London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Amelia
authors.initials: A
authors.lastname: Crampin
authors.affiliation: Rakai Health Sciences program, Kalisizo, Rakai, Uganda.
authors.forename: Tom
authors.initials: T
authors.lastname: Lutalo
authors.affiliation: Rakai Health Sciences program, Kalisizo, Rakai, Uganda.
authors.forename: Richard
authors.initials: R
authors.lastname: Musoke
authors.affiliation: Imperial College London, London, United Kingdom ; Biomedical Research and Training Institute, Harare, Zimbabwe.
authors.forename: Simon
authors.initials: S
authors.lastname: Gregson
authors.affiliation: Imperial College London, London, United Kingdom ; Biomedical Research and Training Institute, Harare, Zimbabwe.
authors.forename: Constance
authors.initials: C
authors.lastname: Nyamukapa
authors.affiliation: Medical Research Council, Entebbe, Uganda.
authors.forename: Jessica
authors.initials: J
authors.lastname: Nakiyingi-Miiro
authors.affiliation: TAZAMA project, National Institute of Medical Research, Mwanza, Tanzania.
authors.forename: Mark
authors.initials: M
authors.lastname: Urassa
authors.affiliation: TAZAMA project, National Institute of Medical Research, Mwanza, Tanzania.
authors.forename: Raphael
authors.initials: R
authors.lastname: Isingo
authors.affiliation: London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Basia
authors.initials: B
authors.lastname: Zaba
mesh_terms: D000293:Adolescent; D000328:Adult; D000818:Animals; D015331:Cohort Studies; D004198:Disease Susceptibility; D062665:Epidemiological Monitoring; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000635:transmission*; D006801:Humans; D008295:Malawi / Q000453:epidemiology; D008875:Middle Aged; D049590:Postpartum Period; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology*; D012307:Risk Factors; D013636:Tanzania / Q000453:epidemiology; D014454:Uganda / Q000453:epidemiology