摘要：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. Some girls infected perinatally with HIV early in the HIV/AIDS epidemic now have reached adolescence and become sexually active. The rate of pregnancy in these adolescent girls and the effectiveness of antiretroviral therapy (ART) in preventing second-generation mother-to-child transmission of HIV are not known. Two case reports have described the pregnancy outcomes of a small number of perinatally infected adolescents in the United States, 1 , 2 and pregnancy outcomes in 28 peri-natally infected adolescents in India have been reported. 3 Although reproductive health outcomes for adolescent girls with behaviorally acquired HIV infection have been studied extensively, little data exist on the reproductive health of girls with perinatal HIV infection. A high risk of genital human papillomavirus infection and its sequelae, cervical squamous intraepithelial lesions (SIL), 4 – 6 as well as other genital infections, 7 has been documented in women and adolescents infected with HIV through sexual activity and drug use. Adolescents perinatally infected with HIV are often cared for in pediatric infectious disease clinics, where reproductive health issues may not be routinely addressed. In this study, we estimated rates of pregnancy and pregnancy outcomes, genital infections, and cervical cytological abnormalities in a cohort of perinatally HIV-infected adolescents in the United States.
