INCIDENCE AND CONSEQUENCES OF PREGNANCY IN WOMEN WITH KNOWN DURATION OF HIV-INFECTION

Background: The increasing incidence of human immunodeficiency virus ( HIV) infection in women of childbearing age led us to evaluate whether pregnancy affects the natural history of this disease. Objectives: To conduct a prospective study of women with known dates of HIV seroconv ersion to describe the incidence and outcome of pregnancy and to asses s differences according to age and exposure group. To compare the rate of disease progression between pregnant and nonpregnant women. Patien ts: All participants, recruited from 14 clinical centers in Italy, had documented HIV-seronegative test results followed by confirmed positi ve test results within 2 years. Results: A total of 331 women, who had seroconversion between 1981 and 1994, were followed up for a median o f 5.5 years from seroconversion; 94 developed HIV-related diseases, 47 developed acquired immunodeficiency syndrome, and 53 had at least 1 C D4 cell count lower than 0.10x10(9/)L (<100 cells/mm(3)). Thirty-eight women (11.5%) were pregnant at the time of HIV seroconversion and 31 (9.4%) became pregnant after HIV seroconversion (cumulative incidence of pregnancy within 8 years of seroconversion, 28.9%; 95% confidence i nterval, 21.6%-36.2%). Forty-five (65.2%) of the 69 pregnancies were c arried to term. There were no discernible differences in these finding s by age or exposure group. Pregnant women did not experience a more r apid rate of progression of disease, even when adjusting for age, expo sure group, CD4 cell count, or use of treatment (adjusted relative haz ards: HIV-related diseases, 0.72; acquired immunodeficiency syndrome, 0.69; CD4 cell count <0.10x10(9)/L, 1.24). Conclusion: Women infected with HIV continue to become pregnant after seroconversion, yet pregnan cy does not appear to influence the rate of progression of HIV disease .