Pregnancy rates and clinical outcomes among women living with HIV enrolled in HPTN 052

ABSTRACT

HPTN 052 was a multi-country clinical trial of cART for preventing heterosexual HIV-1 transmission. The study allowed participation of pregnant women and provided access to cART and contraceptives. We explored associations between pregnancy and clinical measures of HIV disease stage and progression. Of 869 women followed for 5.70 (SD = 1.62) years, 94.7% were married/cohabitating, 96% initiated cART, and 76.3% had >2 past pregnancies. Of 337 women who experienced pregnancy, 89.3% were from countries with lower contraceptive coverage, 56.1% first started cART with PI-based regimens and 57.6% were 25–34 years old. Mean cART duration and condom use were similar among pregnant and nonpregnant individuals. Adjusting for confounders, viral load suppression (VLS) was not (aHR(CI) = 0.82(0.61, 1.08)) and CD4 was slightly associated with decreased rates of first pregnancy over time (aHR(CI) = 0.9(0.84, 0.95)); baseline VLS was associated with increased (aRR(CI) = 2.48(1.71, 3.59)) and baseline CD4 was slightly associated with decreased number of pregnancies (aRR(CI) = 0.9(0.85,0.96)) over study duration. Partner seroconversion was univariably associated with higher rates of first pregnancy (HR(CI) = 2.02(1.32,3.07)). Despite a background of higher maternal morbidity and mortality rates, our findings suggest that becoming pregnant does not pose a threat to maternal health in women with HIV when there is access to medical care and antiretroviral treatment.

KEYWORDS:

• Combination antiretroviral therapy (cART)
• pregnancy
• HIV
• contraception
• women living with HIV (WLH)
• women’s health

Acknowledgements

KNS and TT proposed the research question. SZZ and KNS designed and curated the study. SZZ wrote the manuscript and led the analysis. EAW, SA and SZZ performed statistical analyses. DJD consulted on statistical analyses and reviewed the manuscript. KNS, MCC, MSC, YQC, BG, MM, SVG, MCH, TT and JK were part of HPTN 052 leadership and reviewed the manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This research was partially supported by the National Institutes of Allergy and Infectious Diseases of the National Institutes of Health under awards UM1AI068617-15 and UM1-AI068619. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.