Objective: We aimed to describe temporal changes in substance
use among HIV-infected pregnant women in the United States from 1990 to 2012.
Design: Data came from two prospective cohort studies (Women
and Infants Transmission Study and Surveillance Monitoring for Antiretroviral
Therapy Toxicities Study).
Methods: Women were classified as using a substance during
pregnancy if they self-reported use or had a positive biological sample. To
account for correlation between repeated pregnancies by the same woman,
generalized estimating equation models were used to test for temporal trends
and evaluate predictors of substance use.
Results: Over the 23-year period, substance use among the
5451 HIV-infected pregnant women sharply declined; 82% of women reported
substance use during pregnancy in 1990, compared with 23% in 2012. Use of each
substance decreased significantly (P < 0.001 for each substance) in
an approximately linear fashion, until reaching a plateau in 2006.
Multivariable models showed substance use was inversely associated with
receiving antiretroviral therapy. Among the subset of 824 women with multiple
pregnancies under observation, women who used a substance in their previous
pregnancy were at elevated risk of substance use during their next pregnancy
(risk ratio, 5.71; 95% confidence interval, 4.63–7.05).
Conclusion: A substantial decrease in substance use during
pregnancy was observed between 1990 and 2012 in two large US cohorts of
HIV-infected women. Substance use prevalence in these cohorts became similar to
that of pregnant women in the general US population by the mid-2000s,
suggesting that the observed decrease may be due to an epidemiological
transition of the HIV epidemic among women in the United States.
Purchase full article at: http://goo.gl/GkiJM1
By: Rough K1, Tassiopoulos K, Kacanek D, Griner R, Yogev R, Rich KC, Seage GR 3rd; Pediatric HIVAIDS Cohort Study.
Shearer W, Paul M, Cooper N, Harris L, Purswani M, Stuard E, Cintron A, Puga A, Cooley D, Patton D, Leon D, Yogev R, Sanders MA, Malee K,Hunter S, Borkowsky W, Deygoo S, Rozelman H, Knapp K, Allison K, Acevedo-Flores M, Angeli-Nieves L, Olivera V, Mendez H, Dennie A, Bewley S, Van Dyke R, Craig K, Sirois P, Crain M, Beatty N, Marullo D, Spector S, Manning J, Nichols S, McFarland E, Barr E, McEvoy R, Rathore M,Stowers K, Usitalo A, Rich K, Richardson L, Turpin D, Smith R, Dieudonne A, Bettica L, Adubato S, Scott G, Florez C, Willen E, Frederick T,Davtyan M, Mejia M, Rodriguez Z, Heyer I, Trifilio NS.
- 1Department of Epidemiology bCenter for Biostatistics and AIDS Research, Harvard School of Public Health, Boston, Massachusetts, USA cDepartment of Epidemiology, Biostatistics, and Occupational Health, McGill School of Medicine, Montreal, Quebec, Canada dDepartment of Pediatrics, Lurie Children's Hospital eDepartment of Pediatrics, University of Illinois at Chicago, Chicago, Illinois, USA.
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