Effect of HIV infection on pregnancy-related mortality in sub-Saharan Africa: secondary analyses of pooled community-based data from the network for Analysing Longitudinal Population-based HIV/AIDS data on Africa (ALPHA)

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• 作者：Prof Basia Zaba ; MSc^a ; ^{basia.zaba@lshtm.ac.uk} ; Clara Calvert ; MSc^a ; Milly Marston ; MSc^a ; Raphael Isingo ; MSc^b ; Jessica Nakiyingi-Miiro ; PhD^c ; Tom Lutalo ; MSc^d ; Amelia Crampin ; MD^a ; ^e ; Laura Robertson ; PhD^f ; Kobus Herbst ; FFCH^g ; Prof Marie-Louise Newell ; PhD^g ; Jim Todd ; MSc^a ; Prof Peter Byass ; PhD^h ; ⁱ ; Ties Boerma ; PhD^j ; Prof Carine Ronsmans ; PhD^a
• 刊名：The Lancet
• 出版年：2013
• 出版时间：18-24 May, 2013
• 年：2013
• 卷：381
• 期：9879
• 页码：1763-1771
• 全文大小：237 K

文摘

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Summary

Background

Model-based estimates of the global proportions of maternal deaths that are in HIV-infected women range from 7 % to 21 % , and the effects of HIV on the risk of maternal death is highly uncertain. We used longitudinal data from the Analysing Longitudinal Population-based HIV/AIDS data on Africa (ALPHA) network to estimate the excess mortality associated with HIV during pregnancy and the post-partum period in sub-Saharan Africa.

Methods

The ALPHA network pooled data gathered between June, 1989 and April, 2012 in six community-based studies in eastern and southern Africa with HIV serological surveillance and verbal-autopsy reporting. Deaths occurring during pregnancy and up to 42 days post partum were defined as pregnancy related. Pregnant or post-partum person-years were calculated for HIV-infected and HIV-uninfected women, and HIV-infected to HIV-uninfected mortality rate ratios and HIV-attributable rates were compared between pregnant or post-partum women and women who were not pregnant or post partum.

Findings

138?074 women aged 15-49 years contributed 636?213 person-years of observation. 49?568 women had 86?963 pregnancies. 6760 of these women died, 235 of them during pregnancy or the post-partum period. Mean prevalence of HIV infection across all person-years in the pooled data was 17¡¤2 % (95 % CI 17¡¤0-17¡¤3), but 60 of 118 (50¡¤8 % ) of the women of known HIV status who died during pregnancy or post partum were HIV infected. The mortality rate ratio of HIV-infected to HIV-uninfected women was 20¡¤5 (18¡¤9-22¡¤4) in women who were not pregnant or post partum and 8¡¤2 (5¡¤7-11¡¤8) in pregnant or post-partum women. Excess mortality attributable to HIV was 51¡¤8 (47¡¤8-53¡¤8) per 1000 person-years in women who were not pregnant or post partum and 11¡¤8 (8¡¤4-15¡¤3) per 1000 person-years in pregnant or post-partum women.

Interpretation

HIV-infected pregnant or post-partum women had around eight times higher mortality than did their HIV-uninfected counterparts. On the basis of this estimate, we predict that roughly 24 % of deaths in pregnant or post-partum women are attributable to HIV in sub-Saharan Africa, suggesting that safe motherhood programmes should pay special attention to the needs of HIV-infected pregnant or post-partum women.

Funding

Wellcome Trust, Health Metrics Network (WHO).