Incident pregnancy rates in HIV infected and HIV uninfected at-risk adolescents

To compare pregnancy incidence between HIV infected and HIV uninfected adolescents over a 3-year period and to characterize factors that differentiate pregnant from nonpregnant HIV infected females.

Female adolescents enrolled in Reaching for Excellence in Adolescent Care and Health (REACH), a national cohort study, and nonpregnant at baseline comprised the sample (n = 345). Subject information on pregnancy, risk behavior, and psychosocial characteristics was obtained through interview, chart review, physical examination and laboratory data collected every 3 months. Incident pregnancy rate was analyzed using Cox proportional hazards modeling; the predictors of incident pregnancy were evaluated using repeated measures analysis.

Ninety-four pregnancies were identified over 3 years. No significant difference in pregnancy incidence was detected between HIV infected and uninfected females (20.6 and 28.4 per 100 person-years, respectively, p = .16). However, for adolescents with living children at entry, HIV infected females were significantly less likely to become pregnant than HIV uninfected (HR = .45; p = .03). Among HIV infected adolescents, significant predictors of incident pregnancy were older age (p = .01) and not using hormonal contraception (p = .00), whereas increased spiritual hope and passive problem-solving capacity were protective against pregnancy (p = .02, and.05, respectively). Multivariate analysis revealed pregnancy prior to study entry to be predictive for (OR = 3.0; 95% CI: 1.2-7.7), and increased spiritual hope to be protective (OR = .4; 95% CI: .2-.9) against incident pregnancy in HIV infected females without the hormonal contraceptive variable in the model.

The pregnancy rate is high in this study population. Further research is needed into its determinants and attenuating factors, particularly the role of spiritual elements, to design better contraceptive services and reproduction-related education targeting high-risk youth.