Reproductive health of adolescent girls perinatally infected with HIV

Abstract

Objectives: We sought to describe the reproductive health of adolescent girls perinatally infected with HIV.

Methods: We estimated the incidence of first pregnancy, genital infections, and abnormal cervical cytology for 638 girls aged 13 years and older in the Pediatric AIDS Clinical Trials Group protocol 219C.

Results: Thirty-eight girls became pregnant, for a first pregnancy rate of 18.8/1000 person-years; 7 of these girls had additional pregnancies (95% confidence interval [CI]=13.3, 25.7). Thirty-two pregnancies resulted in live births. All girls received antiretroviral therapy during pregnancy. One infant was HIV infected, 29 were uninfected, and 2 had unknown infection status, for a rate of mother-to-child transmission of HIV in infants with known infection status of 3.3% (95% CI=0.1, 18.6). Condylomata and trichomoniasis were the most frequent genital infections. Forty-eight (47.5%) of 101 girls with Papanicolaou test examinations had abnormal cervical cytology, including atypical cells of undetermined significance (n=18), low-grade squamous intraepithelial lesions (SIL; n=27), and high-grade SIL (n=3). Many abnormalities persisted despite intervention.

Conclusions: Pregnancy rates were lower and cervical abnormalities were higher than among non-HIV-infected adolescents. These findings underscore the importance of Papanicolaou tests and promotion of safer sexual practices in this population.

FIGURE 1—

Cumulative incidence of first pregnancy in 174 perinatally HIV-infected girls aged 13 years and older who were known to be sexually active and were enrolled in Pediatric AIDS Clinical Trials Group (PACTG) protocol 219C.

FIGURE 2—

Cumulative incidence of cervical squamous intraepithelial lesions in 40 perinatally HIV-infected girls aged 13 years and older who were enrolled in Pediatric AIDS Clinical Trials Group (PACTG) protocol 219C.