Similar rates of childbirth, pregnancy, and spontaneous abortion were found between women with HIV infection and the general population between 2009 and 2021. These study findings, from a nationwide cohort study, were published in Open Forum Infectious Diseases.
Data for this study were sourced from national databases in Denmark and the Danish HIV Cohort Study. Between 1995 and 2021, women (n=1288) with HIV infection aged 20 to 40 years without prior hysterectomy or tubal ligation were randomly matched in a 1:10 fashion by date of birth against women (n=12,880) without HIV infection and no history of hysterectomy or tubal ligation. The outcomes of interest were pregnancy, spontaneous and induced abortions, and childbirth. Prior to 2000, HIV-positive women in Denmark were recommended to undergo induced abortion due to mother-to-child-transfer risk. Of note, natural conception has been regarded as safe among virogically-suppressed HIV-positive women since 2010. All comparisons between women with vs without HIV infection were adjusted by age and number of births prior to enrollment.
Among women with and without HIV infection included in the analysis, the median age was 30 (IQR, 27-35) and 30 (IQR, 27-35) years, 3% and 3% had a Charlson comorbidity index score of more than 1, and 31% and 88% were born in Denmark, respectively.
Women with vs without HIV infection had lower rates of childbirth overall (adjusted incidence rate ratio [aIRR], 0.6; 95% CI, 0.6-0.7), tended to have fewer pregnancies (aIRR, 0.9; 95% CI, 0.8-1.0) and spontaneous abortions (aIRR, 0.9; 95% CI, 0.8-1.0), and had higher rates of induced abortions (aIRR, 1.9; 95% CI, 1.6-2.1).
Stratified by year intervals, HIV-positive vs HIV-negative women had lower rates of childbirth between both 1995 and 2001 (aIRR, 0.3; 95% CI, 0.2-0.4) and 2002 and 2008 (aIRR, 0.5; 95% CI, 0.4-0.6). However, from 2009 to 2021, childbirth rates were not significantly different among women with HIV infection (aIRR, 0.9; 95% CI, 0.8-1.0). For pregnancy, rates among HIV-positive women were lower from 1995 to 2001 (aIRR, 0.7; 95% CI, 0.5-0.9), tended to be lower from 2002 to 2008 (aIRR, 0.9; 95% CI, 0.8-1.0), and were not significantly different from 2009 to 2021 (aIRR, 1.0; 95% CI, 1.0-1.1).
Further analysis was performed to assess spontaneous abortion rates between women with and without HIV infection. Results showed that women with HIV infection had lower rates between 1995 and 2001 (aIRR, 0.5; 95% CI, 0.4-0.6) and 2002 and 2008 (aIRR, 0.8; 95% CI, 0.7-0.9) but higher rates between 2009 and 2021 (aIRR, 1.2; 95% CI, 1.1-1.3). In all 3 of these time periods, HIV-positive women had higher rates of induced abortions compared with HIV-negative women.
A sensitivity analysis was conducted after the exclusion of women of African origin. The researchers found that women with vs without HIV infection had lower rates of childbirth (aIRR, 0.4; 95% CI, 0.4-0.5), tended to have lower rates of pregnancy (aIRR, 0.9; 95% CI, 0.8-1.0), and had higher rates of induced abortions (aIRR, 2.1; 95% CI, 1.6-2.5). In regard to spontaneous abortion rates, no significant differences were observed on the basis of HIV status (aRR, 0.9; 95% CI, 0.7-1.2).
These findings may have been limited as there were significant differences in ethnicity between the patient cohorts.
According to the researchers, “The fact that the incidence for induced abortion among WWH [women with HIV] is increased compared to WGP [women from the general population], highlights the continued need for the clinicians who treat WWH to focus on guidance with regards to contraceptives.”
Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Paulsen FW, Tetens MM, Vollmound CV, et al. Incidence of childbirth, pregnancy, spontaneous abortion, and induced abortion among women with human immunodeficiency virus (HIV), a nationwide matched cohort study. Clin Infect Dis. Published online January 31, 2023. doi:10.1093/cid/ciad053