HIV acquisition during pregnancy and postpartum is associated with genital infections and partnership characteristics

• Published in: AIDS (London) Vol. 29; no. 15; pp. 2025 - 2033
• Main Authors: Kinuthia, John, Drake, Alison L, Matemo, Daniel, Richardson, Barbra A, Zeh, Clement, Osborn, Lusi, Overbaugh, Julie, McClelland, R Scott, John-Stewart, Grace
• Format: Journal Article
• Language: English
• Published: England Copyright Wolters Kluwer Health, Inc 24-09-2015
• Subjects: Adult; Chlamydia; Chlamydia Infections - complications; Female; Gonorrhea - complications; HIV Infections - complications; HIV Infections - epidemiology; HIV Infections - transmission; Humans; Incidence; Infectious Disease Transmission, Vertical; Kenya - epidemiology; Lentivirus; Longitudinal Studies; Mycoses - complications; Postpartum Period; Pregnancy; Pregnancy Complications, Infectious; Prospective Studies; Reproductive Tract Infections - complications; Retroviridae; Sexual Behavior; Trichomonas; Trichomonas Infections - complications; Vaginosis, Bacterial - complications; Young Adult; Kenya
• ISSN: 0269-9370; 1473-5571
• DOI: 10.1097/QAD.0000000000000793

OBJECTIVE:The objective of this study is to determine the risk and cofactors for HIV acquisition during pregnancy and postpartum.
DESIGN:A prospective cohort study
METHODS:Pregnant women in western Kenya were enrolled if HIV seronegative at that visit or within 3 months. Serial HIV nucleic acid amplification tests (NAATs) were conducted at 1 to 3-month intervals to 9 months postpartum. Genital swabs were collected for detection of chlamydia and gonorrhoea at baseline, and for trichomonas, bacterial vaginosis and yeast at baseline and follow-up.
RESULTS:Among 1304 pregnant women, median age was 22 years, 78% were married for a median of 4 years, 66% reported knowing partner HIV status and 8% reported using condoms. Study retention was 98%. During 1235 person-years of follow-up, HIV incidence was 2.31/100 person-years [95% confidence interval (95% CI) 0.71–4.10]. Incident HIV was associated with syphilis (hazard ratio 9.18, 95% CI 2.15–39.3), chlamydia (hazard ratio 4.49, 95% CI 1.34–15.0), bacterial vaginosis (hazard ratio 2.91, 95% CI 1.25–6.76), yeast (hazard ratio 3.46, 95% CI 1.46–8.19), sexually transmitted infection (STI) history (hazard ratio 3.48, 95% CI 1.31–9.27), lifetime number of sex partners (hazard ratio 1.19, 95% CI 1.03–1.37), partner age discordance (hazard ratio 1.07 per year, 95% CI 1.02–1.13) and shorter marriage (hazard ratio 1.19 per year, 95% CI 1.03–1.38). No women with incident HIV reported an HIV-infected partner. In multivariate analyses, chlamydia, older partners and yeast infection remained significant; however, power was limited.
CONCLUSION:Pregnant and lactating women may not perceive HIV risk and rarely used condoms. Prevention and treatment of genital infections and risk stratification to identify women for pre-exposure prophylaxis (PrEP) could decrease HIV acquisition in pregnant/lactating women.