Background: 

Birth rates among women living with HIV (WLHIV) have increased recently, with many experiencing multiple pregnancies. Yet, viral suppression is often not sustained between pregnancies. In addition, protease inhibitors (PIs) have been associated with preterm birth, but associations between integrase strand transfer inhibitors (INSTIs) and preterm birth are less well characterized.

Methods: 

We studied WLHIV with ≥2 live-born infants enrolled into the Pediatric HIV/AIDS Cohort Study Surveillance Monitoring for Antiretroviral Treatment Toxicities (SMARTT) study between 2007 and 2018, comparing CD4 counts and viral loads (VLs) between 2 consecutive SMARTT pregnancies. We evaluated associations of covariates with CD4 and viral suppression and the association of PI/INSTI use during pregnancy with odds of preterm birth.

Results: 

There were 736 women who had ≥2 live-born children enrolled in SMARTT (1695 pregnancies). Median CD4 counts remained stable over repeat pregnancies. Although >80% of women achieved VL suppression during pregnancy, more than half had a detectable VL early in their subsequent pregnancy. In adjusted models including all singleton pregnancies, an increased odds of preterm birth was observed for women with first trimester PI initiation (adjusted odds ratio: 1.97; 95% confidence interval: 1.27 to 3.07) compared with those not receiving PIs during pregnancy and for first trimester INSTI initiation (adjusted odds ratio: 2.39; 95% confidence interval: 1.04 to 5.46) compared with those never using INSTIs during pregnancy.

Conclusions: 

Most WLHIV achieved VL suppression by late pregnancy but many were viremic early in subsequent pregnancies. First trimester initiation of PIs or INSTIs was associated with a higher risk of preterm birth.

中文翻译：

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在SMARTT研究中，在美国艾滋病毒携带者中重复怀孕：艾滋病毒感染者的时空变化和早产的预测因素

背景： 

最近，感染艾滋病毒的妇女（WLHIV）的出生率有所提高，其中许多人经历了多次怀孕。然而，在怀孕之间通常不能持续抑制病毒。此外，蛋白酶抑制剂（PIs）与早产有关，但整合酶链转移抑制剂（INSTIs）与早产之间的关联尚不十分清楚。

方法： 

我们对2007年至2018年间纳入儿童儿科HIV / AIDS队列研究监测抗逆转录病毒治疗药物毒性（SMARTT）研究的≥2名活产婴儿进行了WLHIV研究，比较了连续两次SMARTT怀孕之间的CD4计数和病毒载量（VLs）。我们评估了CD4与病毒抑制的协变量关联，以及妊娠期PI / INSTI使用与早产几率的关联。

结果： 

SMARTT登记了736名育有≥2个活产儿的妇女（1695例怀孕）。在重复怀孕期间，CD4的中位数保持稳定。尽管> 80％的妇女在怀孕期间达到了VL抑制，但超过一半的妇女在随后的怀孕初期都有可检测到的VL 。在包括所有单胎妊娠的调整模型中，与怀孕期间和第一次妊娠未接受过PI的女性相比，孕早期开始PI的女性早产发生率有所提高（经调整的优势比：1.97； 95％置信区间：1.27至3.07）。与孕期从未使用INSTIs的人相比，孕早期INSTI的发起人（调整后的优势比：2.39； 95％置信区间：1.04至5.46）。

结论： 

大多数WLHIV在妊娠晚期达到了VL抑制，但许多在随后的怀孕早期就出现病毒血症。PIs或INSTIs的孕早期开始与早产风险高有关。