Pregnancies before and after HIV diagnosis in a European cohort of HIV-infected women

FRANÇAIS :
L'étude européenne sur le développement naturel de l'infection VIH chez les femmes, mise en place depuis 1993, porte sur une cohorte propective de 485 participantes (dont 106 UDVIs) dont l'intervalle de séroconversion VIH est connu, recrutées dans 31 centres de 12 pays européens. L'incidence des grossesses diminue avec la progression de l'infection VIH et le nombre d'avortements provoqués, élevé avant diagnostic d'une séropositivité VIH, augmente significativement après (42% vs 53%). Les grossesses après contamination par le VIH semblent largement liées à des facteurs culturels et sociaux (taux plus élevé en Europe du nord et en Europe centrale, comparativement à l'Europe du sud).
ENGLISH :
Objectives: Because most HIV-infected women are of reproductive age, we investi- gated whether their reproduction planning was affected by their HIV diagnosis. Design: The European women study is a prospective, multicentre cohort of 485 HIV-infected women with a known interval of seroconversion. Methods: The incidence of pregnancy was measured with person-time methods. Generalized estimating equation analysis was used to determine risk factors for pregnancy and pregnancy outcomes. Results: In 449 women, the age-adjusted incidence of pregnancies decreased from 8.6 before HIV diagnosis to 8.2 and 6.0 per 100 person-years in 0-4 and over 4 years after HIV diagnosis, respectively (P= 0.14). The proportion of induced abortions increased from 42% before to 53% after HIV diagnosis (P< 0.05). The risk of spontaneous abortion did not increase as a result of HIV infection. Since 1995, the proportion of births increased (P= 0.009), whereas that of induced abortions decreased (P= 0.01) compared with earlier years. An increased risk of pregnancy after HIV diagnosis was found in northern and central European women compared with southern European women; there was a lower risk in single women than in women with a steady partner. Of all pregnant women, single women, women between 15 and 25 years of age, and women with multiple partners were at increased risk for induced abortion both before and after HIV diagnosis. Conclusion: The incidence of pregnancy decreased with HIV disease progression. Pregnancies after HIV diagnosis appear to be related largely to social and cultural attitudes. The number of induced abortions was high before HIV diagnosis and it significantly increases thereafter. (Author' s abstract)