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Incident HIV during Pregnancy and Postpartum and Risk of Mother-to-Child HIV Transmission: A Systematic Review and Meta-Analysis

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  • Alison L Drake
  • Anjuli Wagner
  • Barbra Richardson
  • Grace John-Stewart

Abstract

: Alison Drake and colleagues conduct a systematic review and meta-analysis to estimate maternal HIV incidence during pregnancy and the postpartum period and to compare mother-to-child HIV transmission risk among women with incident versus chronic infection. Background: Women may have persistent risk of HIV acquisition during pregnancy and postpartum. Estimating risk of HIV during these periods is important to inform optimal prevention approaches. We performed a systematic review and meta-analysis to estimate maternal HIV incidence during pregnancy/postpartum and to compare mother-to-child HIV transmission (MTCT) risk among women with incident versus chronic infection. Methods and Findings: We searched PubMed, Embase, and AIDS-related conference abstracts between January 1, 1980, and October 31, 2013, for articles and abstracts describing HIV acquisition during pregnancy/postpartum. The inclusion criterion was studies with data on recent HIV during pregnancy/postpartum. Random effects models were constructed to pool HIV incidence rates, cumulative HIV incidence, hazard ratios (HRs), or odds ratios (ORs) summarizing the association between pregnancy/postpartum status and HIV incidence, and MTCT risk and rates. Overall, 1,176 studies met the search criteria, of which 78 met the inclusion criterion, and 47 contributed data. Using data from 19 cohorts representing 22,803 total person-years, the pooled HIV incidence rate during pregnancy/postpartum was 3.8/100 person-years (95% CI 3.0–4.6): 4.7/100 person-years during pregnancy and 2.9/100 person-years postpartum (p = 0.18). Pooled cumulative HIV incidence was significantly higher in African than non-African countries (3.6% versus 0.3%, respectively; p

Suggested Citation

  • Alison L Drake & Anjuli Wagner & Barbra Richardson & Grace John-Stewart, 2014. "Incident HIV during Pregnancy and Postpartum and Risk of Mother-to-Child HIV Transmission: A Systematic Review and Meta-Analysis," PLOS Medicine, Public Library of Science, vol. 11(2), pages 1-16, February.
    • Handle: RePEc:plo:pmed00:1001608
    DOI: 10.1371/journal.pmed.1001608
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    Cited by:

    1. Sphiwe Madiba, 2021. "When Pregnancy Coincides with Positive Diagnosis of HIV: Accounts of the Process of Acceptance of Self and Motherhood among Women in South Africa," IJERPH, MDPI, vol. 18(24), pages 1-14, December.
    2. Zinhle Shabangu & Sphiwe Madiba, 2019. "The Role of Culture in Maintaining Post-Partum Sexual Abstinence of Swazi Women," IJERPH, MDPI, vol. 16(14), pages 1-14, July.
    3. Renee Heffron & Craig R Cohen & Kenneth Ngure & Elizabeth Bukusi & Edwin Were & James Kiarie & Nelly Mugo & Connie Celum & Jared M Baeten & Partners PrEP Study, the Partners in Prevention HSV/HIV Tran, 2015. "A Scoring Tool to Identify East African HIV-1 Serodiscordant Partnerships with a High Likelihood of Pregnancy," PLOS ONE, Public Library of Science, vol. 10(12), pages 1-14, December.

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