Cofactors for HIV-1 Incidence during Pregnancy and Postpartum Period

John Kinuthia, James N Kiarie, Farquhar C, Ruth Nduati, and Dorothy Mbori-Ngacha GJ-S. "Cofactors for HIV-1 Incidence during Pregnancy and Postpartum Period." Curr HIV Res. 2010 October ; 8(7): 510–514.. 2010.


Objectives—To estimate HIV-1 incidence and cofactors for HIV-1 incidence during pregnancy
and postpartum.
Design—Retrospective study among women who were HIV seronegative during pregnancy.
Methods—Mothers accompanying their infants for routine 6-week immunizations at 6 maternal
child health clinics in Nairobi and Western Kenya were tested for HIV-1 after completing a
questionnaire that included assessment of sociodemographics, obstetric history and HIV-1 risk
Results—Of 2,135 mothers who had tested HIV-1 seronegative antenatally, 2,035 (95.3%)
accepted HIV-1 re-testing at 6 weeks postpartum. Of these, 53 (2.6%) were HIV-1 seropositive
yielding an estimated HIV-1 incidence of 6.8 (95% CI: 5.1-8.8) per 100 woman-years). Mothers
who seroconverted were more likely to be employed (45.3% vs 29.0%, p=0.01), married (96.2 vs
86.6%, p=0.04) and from a higher HIV-1 prevalence region (60.4% in Western Kenya vs 28.8% in
Nairobi, p<0.001). Among married women, those in polygamous relationship were significantly
more likely to seroconvert (19.6% vs 6.7%, p<0.001). In multivariate analysis, region and
employment independently predicted seroconversion.
Conclusions—Repeat HIV-1 testing in early postpartum was highly acceptable and resulted in
detection of substantial HIV-1 incidence during pregnancy and postpartum period. Within
prevention of mother-to-child HIV-1 transmission programs strategic approaches to prevent
maternal HIV-1 acquisition during pregnancy are urgently needed.

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