The risk of acquiring HIV rises during pregnancy, accordingto a study of women in Uganda’s Rakai District led by researchers atthe Johns Hopkins Bloomberg School of Public Health. The increased riskfor acquiring HIV remained even after researchers controlled forbehavior and other factors that contribute to HIV risk. The findings,which are published in the September 30, 2005, edition of The Lancet,suggest that the increased risk was likely due to biological changesduring pregnancy.
“We cannot generalize our findings beyond theRakai setting and it would be important for other investigators toverify our results. However, if women are at increased risk of HIVacquisition during pregnancy, our findings represent a public-healthproblem, both for the mother and possibly her unborn infant,” said thestudy’s lead author Ronald Gray, MD, the Robertson Professor ofReproductive Epidemiology in the Bloomberg School’s Department ofPopulation and Family Health Sciences. “We believe that it would beprudent to warn women of this potential risk of HIV acquisition duringpregnancy and promote safe sex or sexual abstinence where feasible.”
Thestudy supports the findings of two previous studies that reported agreater risk of acquiring HIV during pregnancy than after delivery.However, neither study accounted for risk factors that contribute toHIV risk.
Gray and his colleagues assessed 2,188 HIV-negativewomen who were sexually active and were pregnant or breastfeeding, andcompared their rates of HIV acquisition to 8,473 women who were neitherpregnant nor lactating. They compared the incidence rates of HIV duringpregnancy and breastfeeding with the rates during intervals whenpregnancy and breastfeeding were absent. The sexual behaviors ofhusbands of married women in the study were also assessed.
Accordingto the investigators, the rate of HIV acquisition was higher duringintervals of pregnancy than during breastfeeding or during intervalswith neither. The results of the study showed HIV incidence ratesduring pregnancy were 2.3 percent per year whereas HIV incidence rateswere 1.3 percent per year during breastfeeding and 1.1 percent per yearfor women who were not pregnant or breastfeeding. The risk for HIVremained higher even after the investigators adjusted for other HIVrisk factors.
“It is unlikely that the change in HIV risk weobserved is due to sexual behaviors. It may be attributed to hormonalchanges affecting the genital tract mucosa or immune responses,” saidGray.
Additional study authors include Xianbin Li and HennaBrahmbhatt of the Johns Hopkins Bloomberg School of Public Health;Godfrey Kigozi, Fred Nalugoda and Mohamed Kiddugavu of the Rakai HealthSciences Programme at the Uganda Virus Research Institute; DavidSerwaddo and Fred Wabwire-Mangen of the Institute for Public Health atMakerere University; Nelson Sewankambo at the Makerere UniversitySchool of Medicine; Thomas C. Quinn and Steven J. Reynolds of the JohnsHopkins School of Medicine; and Maria J. Wawer of the Mailman School ofPublic Health at Columbia University.
The research was funded bygrants from the National Institute of Allergy and Infectious Diseases,the National Institute of Child Health and Development, the HenryJackson Foundation for the Advancement of Military Medicine, the UnitedStates Department of Defense and the Bill and Melinda Gates Instituteof Population and Reproductive Health at the Johns Hopkins BloombergSchool of Public Health.
The above story is based on materials provided by Johns Hopkins University Bloomberg School of Public Health. Note: Materials may be edited for content and length.
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