Predictors of pregnancy and changes in pregnancy incidence among HIV-positive women accessing HIV clinical care

Objectives: To describe predictors of pregnancy and changes in pregnancy incidence among HIV-positive women accessing HIV clinical care. Methods: Data were obtained through the linkage of two separate studies: the UK Collaborative HIV Cohort study (UK CHIC), a cohort of adults attending 13 large HIV clinics; and the National Study of HIV in Pregnancy and Childhood (NSHPC), a national surveillance study of HIV-positive pregnant women. Pregnancy incidence was measured using the proportion of women in UK CHIC with a pregnancy reported to NSHPC. Generalized estimating equations were used to identify predictors of pregnancy and assess changes in pregnancy incidence in 2000–2009. Results: The number of women accessing care at UK CHIC sites increased as did the number of pregnancies. Older women were less likely to have a pregnancy [adjusted relative rate (aRR) 0.44 per 10 year increment in age, [95% confidence interval (CI) (0.41–0.46)], P < 0.001] as were women with CD4 cell count less than 200 cells/μl compared with CD4 cell count 200–350 cells/μl [aRR 0.65 (0.55–0.77), P < 0.001] and women of white ethnicity compared with women of black African ethnicity [aRR 0.67 (0.57–0.80), P < 0.001]. The likelihood that women had a pregnancy increased over the study period [aRR 1.05 (1.03–1.07), P < 0.001). The rate of change did not significantly differ according to age group, antiretroviral therapy use, CD4 group or ethnicity. Conclusion: The pregnancy rate among women accessing HIV clinical care increased in 2000–2009. HIV-positive women with, or planning, a pregnancy require a high level of care and this is likely to continue and increase as more women of older age have pregnancies