Teens with HIV at high risk for pregnancy, complications, research finds

A report on the multi-center study, based on an analysis of records from 181 patients with HIV, ages 13 to 24, treated at four hospitals over 12 years, will be published in the Feb. 2 issue of the Journal of the American Medical Association.

The findings are alarming for at least two reasons, the investigators say. First, teen pregnancies -- planned or not -- put these already vulnerable patients and their fetuses in grave danger for complications. Second, the findings signal that HIV-infected teens and young women continue to practice unsafe sexual behaviors and to have unprotected sex, the researchers say.

Pregnancy rates were especially high in one subgroup of HIV-infected youth -- teens who acquired the virus behaviorally rather than during birth. Behaviorally infected teens had five times the number of pregnancies compared to their HIV-negative counterparts and were more prone to premature births and spontaneous abortions than their HIV-negative peers.

Because of its retrospective nature, the study did not capture why the patients got pregnant. The answer to this question, the researchers say, would supply critical information for future pregnancy-counseling and risk-reduction efforts.

"Our analysis revealed a problem. Now we need to figure out why that is and how we, as providers, can give appropriate counseling and care to these girls and women," says lead investigator Allison Agwu, M.D., Sc.M., a pediatric infectious disease specialist at the Johns Hopkins Children's Center.

All HIV-infected patients should be informed about pregnancy risk, including the risk of transmitting HIV to their partners during attempts to become pregnant and to their babies during the pregnancy itself, the researchers say. Therefore, physicians who treat HIV-infected youth should have regular and honest discussion about these risks, they say.

More than one-third (66) of the 181 patients in the study got pregnant, some of whom had more than one pregnancy for a total of 96 pregnancies. Premature births were more common among HIV-infected mothers (34 percent), compared with moms in the general population (22 percent) as were spontaneous abortions, 14 percent among HIV-infected moms compared with 9 percent among pregnant women in the general population.

Twenty-eight of the 130 teen girls and women infected at birth got pregnant compared with 38 of those 51 who were behaviorally infected. The pregnancy rate of behaviorally infected patients was seven times higher than the rate of those infected at birth, the researchers found. Teen girls and women with behaviorally acquired HIV tended to have repeated pregnancies more often -- 37 percent of them had more than one pregnancy -- than their counterparts infected at birth, of whom 14 percent got pregnant more than once.

Those infected at birth were four times more likely to choose to terminate the pregnancy -- 41 percent of them did so -- compared with those who contracted HIV later in life, 10 percent of whom ended the pregnancy.

Despite the small number of patients involved in the study, the researchers say their analysis shows intriguing differences among youth with HIV, depending on how they got infected in the first place.

"Our findings suggest that teens who were infected with HIV later in life may engage in different sexual behaviors than those infected at birth. Further analysis into these differences will help us find ways to prevent unwanted pregnancies and avoid complications from planned ones," said senior investigator Kelly Gebo, M.D., M.P.H., a Johns Hopkins infectious disease specialist.

Funding for the study came from the National Institutes of Health and the Doris Duke Charitable Foundation.

Conflict-of-interest disclosure: Kelly Gebo has received research funding from Tibotec, developer of anti-infective pharmaceuticals, including HIV/AIDS drugs. The terms of these arrangements are being managed by The Johns Hopkins University in accordance with its conflict-of-interest policies.

Co-authors on the study: Susie Jang, M.D., of the Beth Israel Deaconess Medical Center in Boston; P. Todd Korthuis, M.D. M.P.H., of Oregon Health and Science University in Portland, Ore.; and Maria Rosario G. Araneta, Ph.D., of the University of California-San Diego.