Relative time to pregnancy among HIV-infected and uninfected women in the Women's Interagency HIV Study, 2002–2009

Linas, Beth S.; Minkoff, Howard; Cohen, Mardge H.; Karim, Roksana; Cohan, Deborah; Wright, Rodney; Young, Mary; Watts, D. Heather; Golub, Elizabeth T.

doi:10.1097/qad.0b013e3283445811

Cited by 24 publications

(17 citation statements)

References 11 publications

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“…Among these were studies which performed secondary analysis of data from a trial which had, itself, excluded pregnant women; studies which mentioned pregnancy exclusions on the trial registration website, but not in the paper; studies which used an all-male cohort or analysis to answer a research question which was not male-specific; or studies for which exclusions were only communicated by email, not in the paper. Two studies [50,51] examined an outcome of incident pregnancy but excluded prevalent pregnancies; we did not count these two studies as excluding pregnant women.…”

Section: Resultsmentioning

confidence: 99%

Representation of Women and Pregnant Women in HIV Research: A Limited Systematic Review

et al. 2013

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BackgroundHIV-related outcomes may be affected by biological sex and by pregnancy. Including women in general and pregnant women in particular in HIV-related research is important for generalizability of findings.ObjectiveTo characterize representation of pregnant and non-pregnant women in HIV-related research conducted in general populations.Data SourcesAll HIV-related articles published in fifteen journals from January to March of 2011. We selected the top five journals by 2010 impact factor, in internal medicine, infectious diseases, and HIV/AIDS.Study Eligibility CriteriaHIV-related studies reporting original research on questions applicable to both men and women of reproductive age were considered; studies were excluded if they did not include individual-level patient data.Study appraisal and synthesis methods.Articles were doubly reviewed and abstracted; discrepancies were resolved through consensus. We recorded proportion of female study participants, whether pregnant women were included or excluded, and other key factors.ResultsIn total, 2014 articles were published during this period. After screening, 259 articles were included as original HIV-related research reporting individual-level data; of these, 226 were determined to be articles relevant to both men and women of reproductive age. In these articles, women were adequately represented within geographic region. The vast majority of published articles, 183/226 (81%), did not mention pregnancy (or related issues); still fewer included pregnant women (n=33), reported numbers of pregnant women (n=19), or analyzed using pregnancy status (n=9).LimitationsData were missing for some key variables, including pregnancy. The time period over which published works were evaluated was relatively short.Conclusions and implications of key findings.The under-reporting and inattention to pregnancy in the HIV literature may reduce policy-makers’ ability to set evidence-based policy around HIV/AIDS care for pregnant women and women of child-bearing age.

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Section: Resultsmentioning

confidence: 99%

Representation of Women and Pregnant Women in HIV Research: A Limited Systematic Review

et al. 2013

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“…However, we did not attempt to evaluate HIV as a risk factor for breast cancer because we were unable to adjust for potentially confounding factors, such as parity, age at first birth, and body mass index, which are associated with both HIV and breast cancer [22]. …”

Section: Discussionmentioning

confidence: 99%

Breast cancer characteristics and HIV among 1,092 women in Soweto, South Africa

Cubasch

Joffe

Hanisch

et al. 2013

Breast Cancer Res Treat

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In the low-income HIV-endemic regions of sub-Saharan Africa, malignancies related to HIV have long been recognized as a major public health problem. However, epithelial malignancies associated with older age, such as breast cancer, are also rising dramatically in those regions. We compared consecutive HIV-positive and -negative black women diagnosed with breast cancer at a large public hospital in Soweto, South Africa, on age, year of diagnosis, stage, grade, and receptor status, and grouped HIV-positive patients by CD4 cell counts. We computed prevalence ratios of the associations of HIV status and CD4 category with stage, grade, receptor status, and among the HIV-positive patients, receipt of ART, controlling for age and year of diagnosis. Of 1,092 patients, 765 were tested for HIV; 151 (19.7 %) tested positive, a prevalence similar to that in the source population. Although, HIV-positive patients were younger than HIV-negative patients (p < 0.001), HIV status was not associated with the tumor characteristics. Thirty-seven women (25.9 %) had CD4 cell counts <200 cells/μl. Patients in that severely immunocompromised group were older than those in the other groups (p = 0.01). This study is the first to analyze the association of HIV with breast cancer in a large sample. Based on similar HIV prevalence in our sample and the population of the hospital’s catchment area, clinicians serving HIV-endemic communities should promote routine HIV testing of younger breast cancer patients and immediate treatment of those who test positive, prior to the initiation of chemotherapy. Research is needed on treatment and outcomes given HIV and low CD4 cell count.

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“…A 1994-2002 Women's Interagency HIV Study (WIHS, an ongoing multicenter prospective cohort study of HIV infection and outcomes among women with and without HIV) analysis found pregnancy rates of 7.4 and 15.2/100 person-years among HIV-positive and high-risk negative women, respectively 11 . In a more recent 2002-2009 WIHS study, Linas et al reported that HIV infection was associated with a 40% reduction in pregnancy incidence among HIV-positive versus HIV-negative women adjusting for age, number of sexual partners, contraception, parity and alcohol use 15 .…”

Section: Introductionmentioning

confidence: 99%

Trends of and factors associated with live-birth and abortion rates among HIV-positive and HIV-negative women

Haddad

Wall

Mehta

et al. 2017

American Journal of Obstetrics and Gynecology

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Background Little is known about fertility choices and pregnancy outcome rates among HIV-infected women in the current combination ART era. Objective To describe trends and factors associated with live-birth and abortion rates among HIV-positive and high-risk HIV-negative women enrolled in the Women’s Interagency HIV Study (WIHS) in the United States. Study Design We analyzed longitudinal data collected from October 1st 1994 to September 30th 2012 through WIHS. Age-adjusted rates per 100 person-years (PY) live-births, and induced abortions were calculated by HIV serostatus over four time periods. Poisson mixed effects models containing variables associated with live-births and abortions in bivariable analyses (p<0.05) generated adjusted incidence rate ratios (aIRRs) and 95% confidence intervals. Results There were 1,356 pregnancies among 2,414 women. Among HIV-positive women, age-adjusted rates of live-birth increased from 1994-1997 to 2006-2012 (2.85/100PY to 7.27/100PY, p-trend<0.0001). Age-adjusted rates of abortion in HIV-positive women remained stable over these time periods (4.03/100PY to 4.29/100PY, p-trend=0.09). Significantly lower live-birth rates occurred among HIV-positive compared to HIV-negative women in 1994-1997 and 1997-2001, however rates were similar during 2002-2005 and 2006-2012. Higher CD4+ T cells/mm3 (≥350 aIRR=1.39 [1.03-1.89] versus <350) was significantly associated with increased live-birth rates, while combination antiretroviral treatment (cART) use (aIRR=1.35 [0.99-1.83]) was marginally associated with increased live-birth rates. Younger age, having a prior abortion, condom use and increased parity were associated with increased abortion rates among both HIV-positive and HIV-negative women. CD4+ T-cell count, cART use, and viral load were not associated with abortion rates. Conclusions Unlike earlier periods (pre-2001) when live-birth rates were lower among HIV-positive women, rates are now similar to HIV-negative women, potentially due to improved health status and cART. Abortion rates remain unchanged illuminating a need to improve contraceptive services.

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Relative time to pregnancy among HIV-infected and uninfected women in the Women's Interagency HIV Study, 2002–2009

Cited by 24 publications

References 11 publications

Representation of Women and Pregnant Women in HIV Research: A Limited Systematic Review

Representation of Women and Pregnant Women in HIV Research: A Limited Systematic Review

Breast cancer characteristics and HIV among 1,092 women in Soweto, South Africa

Trends of and factors associated with live-birth and abortion rates among HIV-positive and HIV-negative women

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