Abstract 700 - Have Pregnancy Rates in Human Immunodeficiency Virus- Infected Women Changed in the Era of Effective Antiretroviral Therapy for Prevention of Perinatal Transmission?

700 Have Pregnancy Rates in Human Immunodeficiency Virus- Infected Women Changed in the Era of Effective Antiretroviral Therapy for Prevention of Perinatal Transmission?

J. M. Blair*, D. L. Hanson, J. L. Jones, and M. S. Dworkin.
CDC, Atlanta, GA.

Background:In 1994, antiretroviral therapy (ART) regimens containing zidovudine (ZDV) were shown to decrease the risk for perinatal human immunodeficiency virus (HIV) transmission from 25% to 8%. Additionally, clinical improvements in HIV disease in women prescribed highly active antiretroviral therapy (HAART), which became available in late 1995, may have changed women's reproductive decisions. We postulated that pregnancy rates among HIV-infected women may have increased in response to this lower risk of HIV transmission.

Methods:The study population consisted of HIV-infected women aged 15—44 years enrolled in the Adult and Adolescent Spectrum of HIV Disease Project (ASD) from 1991 through 1998. ASD is a prospective, observational dynamic cohort study conducted in 10 U.S. cities and Puerto Rico among HIV-infected persons>13 years of age. Annual pregnancy rates were calculated for the observation time following enrollment. Poisson regression was used to compute adjusted rate ratios (RR) for the association between various factors and pregnancy.

Results:Among 7,267 women, there were 789 pregnancies during 13,978 person-years of follow-up; the overall pregnancy rate was 5.6/100 person-years. Pregnancy rates were highest among women aged 15—24 (RR = 11.2, 95% confidence interval [CI] = 8.5—14.7) compared to women 35—44. Pregnancy rates were higher for black women (RR = 1.3, 95% CI = 1.0—1.6) than for white women. Pregnancy rates did not change significantly during 1995—1998 compared with 1991—1994 (RR = 1.0, 95% CI = 0.9—1.1). New pregnancies were less likely to occur among women with an AIDS opportunistic illness (RR = 0.5, 95% CI = 0.4 —0.7) compared to women with HIV, not AIDS. Women who received HAART were not more likely to become pregnant than women who were not receiving therapy (RR = 1.0, 95% CI = 0.8—1.4).

Conclusions:The availability of HAART in late 1995 was not associated with an increase in pregnancy rates. However, high rates among certain subgroups suggest the continued need for integrated programs that include HIV care, family planning, social services, and counseling. Access to family planning, especially for young women who are at high risk of HIV infection, is critical.