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Substance use drops sharply in pregnant US women with HIV

Substance-Use-Drops-SharplySubstance use drops sharply in pregnant US women with HIV

Pregnant and LWHA

By Mark Mascolini

Proportions of pregnant HIV-positive US women who reported substance use or tested positive for substance use fell sharply from 1990 to 2012, according to analysis of two large prospective cohorts. Researchers believe the decline may reflect an epidemiologic shift in the US HIV epidemic.

Substance use poses a grave threat to the fetus of pregnant women and to the women themselves. Because drug injection is not an uncommon HIV transmission route in the United States, substance use may be more frequent among pregnant HIV-positive US women than women with HIV in other countries.

To track rates of substance use in pregnant US women with HIV from 1990 to 2012, researchers analyzed findings from two large prospective cohorts, the Women and Infants Transmission Study and Surveillance Monitoring for Antiretroviral Therapy Toxicities Study.  They classified a woman as a substance user if she self-reported use or had a positive sample.

Over the 23 years of study, substance use among 5451 pregnant women fell from a rate of 82% in 1990 to 23% in 2012. Use of each recorded substance fell significantly (P < 0.001) over the study period. Declines of individual substances were approximately linear until 2006, when the drop plateaued.

Multivariable statistical analysis identified an inverse association between substance use and taking antiretroviral therapy (ART)—meaning women on ART were less likely to use substances during pregnancy.

The analysis included 824 women with multiple pregnancies during the study period.

Women who used a substance during a previous pregnancy were almost six times more likely to use a substance during their next pregnancy (risk ratio 5.71, 95% confidence interval 4.63 to 7.05).

Among all women studied, substance use rates during pregnancy became similar to the rate in the general US population of pregnant women.

Thus the authors suggest that “the observed decrease may be due to an epidemiological transition of the HIV epidemic among women in the United States.”

Source: Kathryn Rough, Katherine Tassiopoulos, Deborah Kacanek, Raymond Griner, Ram Yogev, Kenneth C. Rich, George R. Seage. Dramatic decline in substance use by HIV-infected pregnant women in the United States from 1990 to 2012. AIDS. 2015; 29: 117-123.

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